{"hospital_name": "Washington County Healthcare Authority, Inc", "last_updated_on": "2026-05-05", "version": "3.0.0", "pid": "2898637794", "rid": "13567", "location_name": ["Washington County Hospital & Nursing Home"], "hospital_address": ["14600 St Stephens Ave, Chatom, AL 36518"], "type_2_npi": ["1487699203"], "license_information": {"license_number": "H6501", "state": "AL"}, "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": "Chesla Sollie"}, "standard_charge_information": [{"description": "\"\"Y SET\"\" TUBING", "code_information": [{"code": "A4719", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "#", "code_information": [{"code": "3000050", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#", "code_information": [{"code": "3000332", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#", "code_information": [{"code": "3000369", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#", "code_information": [{"code": "3000503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#", "code_information": [{"code": "3001000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#", "code_information": [{"code": "3001001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#", "code_information": [{"code": "3001044", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#", "code_information": [{"code": "3001113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "# DO NOT USE", "code_information": [{"code": "3000068", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "# DO NOT USE", "code_information": [{"code": "3000505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "# DO NOT USE", "code_information": [{"code": "3000538", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "# DO NOT USE", "code_information": [{"code": "3001046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "# DO NOT USE", "code_information": [{"code": "80001102", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3000060", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3000392", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.02, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3000563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3000582", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3000612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3001015", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3001016", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3001032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3001202", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3001207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3001208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3001209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "3001218", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "##DO NOT USE##", "code_information": [{"code": "80000856", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "#DO NOT USE", "code_information": [{"code": "3000036", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "* DO NOT USE", "code_information": [{"code": "3000075", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "******VITAMIN E 180MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004500", "type": "CDM"}, {"code": "00536135201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "****ENFIT SYRINGE 60CC", "code_information": [{"code": "3001465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "***ALEVE (NAPROXEN) TAB 375MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000741", "type": "CDM"}, {"code": "65162018910", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "***DO NOT USE***", "code_information": [{"code": "3000450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "***DO NOT USE***", "code_information": [{"code": "3000451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "**DO NOT USE**", "code_information": [{"code": "3000368", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "**DO NOT USE**", "code_information": [{"code": "3000383", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "**DO NOT USE**", "code_information": [{"code": "3000618", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "**DO NOT USE**", "code_information": [{"code": "3001234", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.18, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*AED DEFIBRILLATOR PADS", "code_information": [{"code": "3001230", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 98.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*BENADRYL (DIPHENHYDRAMINE) 50MG IV*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1200", "type": "HCPCS"}, {"code": "7000160", "type": "CDM"}, {"code": "00641037625", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 18.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*BICILLIN LA 2.4MMU/4ML IM*", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0540", "type": "HCPCS"}, {"code": "7000072", "type": "CDM"}, {"code": "60793070110", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 66.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*BLADE MILLER #3 LARYNGOSCOPE", "code_information": [{"code": "3001176", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.72, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*CATH IV 18GA X 1", "code_information": [{"code": "3000448", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*CATH IV 20GA X 1", "code_information": [{"code": "3001022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*CATH IV 22GA X 1", "code_information": [{"code": "3000452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*CATH IV 24GA X .75", "code_information": [{"code": "3000453", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*CEFZIL (CEFPROZIL) INJ : 125MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000089", "type": "CDM"}, {"code": "00087771862", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*COLLAR CERVICAL FR M", "code_information": [{"code": "3000127", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*COLLAR CERVICAL FR S", "code_information": [{"code": "3000128", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*COLLAR STIFNECK SELECT COLLAR", "code_information": [{"code": "3000134", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*COPY PAPER YELLOW 8 1/2 X 11", "code_information": [{"code": "80000745", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 1503.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*D5W NS 0.225% 1000ML*", "drug_information": {"unit": 12.0, "type": "EA"}, "code_information": [{"code": "J7070", "type": "HCPCS"}, {"code": "72000342", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*DERMAFILM X-THIN HYDROCOLLOID DRESS.4X4", "code_information": [{"code": "3001330", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*DERMASYN HYDROGEL 3OZ", "code_information": [{"code": "3001327", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*DEXTROSE 5% / .45% NS 500ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7042", "type": "HCPCS"}, {"code": "7200009", "type": "CDM"}, {"code": "00338008503", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*DEXTROSE 5% 100ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "Q0081", "type": "HCPCS"}, {"code": "7200005", "type": "CDM"}, {"code": "00338001748", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 966.98, "gross_charge": 20.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*DEXTROSE 5% 500ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7060", "type": "HCPCS"}, {"code": "7200008", "type": "CDM"}, {"code": "00338001703", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "estimated_discounted_cash": 23.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*DEXTROSE 5% WATER ADDV : 50ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200011", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*DEXTROSE 5%/0.9% NS 500ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7042", "type": "HCPCS"}, {"code": "7200023", "type": "CDM"}, {"code": "00264775100", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*DEXTROSE 5/0.2% 500ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200004", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*DO NOT USE*", "code_information": [{"code": "3001229", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 0.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*FORM INFLUENZA CONSENT", "code_information": [{"code": "80000746", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 1503.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*GENTAMICIN SULFATE 80MG IM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1580", "type": "HCPCS"}, {"code": "72000534", "type": "CDM"}, {"code": "63323001002", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*GLOVES STERILE LATEX FREE MED", "code_information": [{"code": "3001250", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*GOWN SURGICAL STER XL", "code_information": [{"code": "3000498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*HEP LOCK CATH", "code_information": [{"code": "3000500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*IMMOBILIZER KNEE 24 MED", "code_information": [{"code": "3000208", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 43.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*IMMOBILIZER SHOULDER XL", "code_information": [{"code": "3001137", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*IV BLOOD SOLUTION SET Y-TYPE", "code_information": [{"code": "3000418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*IV START KIT", "code_information": [{"code": "3000515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*IV TUBING 10GTT", "code_information": [{"code": "3000504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*IV TUBING 60GTT", "code_information": [{"code": "3000511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*KNEE IMMOBILIZER LGE 24", "code_information": [{"code": "3001106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*LACTATED RINGERS : 1000ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000164", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*LACTATED RINGERS IVSL : 500ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7120", "type": "HCPCS"}, {"code": "7200026", "type": "CDM"}, {"code": "00338011703", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.7, "maximum": 9.0, "gross_charge": 10.0, "discounted_cash": 54.17, "estimated_discounted_cash": 22.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*LASIX (FUROSEMIDE) 80MG IV", "drug_information": {"unit": 8.0, "type": "EA"}, "code_information": [{"code": "J1938", "type": "HCPCS"}, {"code": "72000580", "type": "CDM"}, {"code": "00409610202", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 16.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*LEVEMIR INSULIN : 10ML*", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "72000434", "type": "CDM"}, {"code": "00169368712", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*MAGNESIUM SULF 1GM/100ML NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3475", "type": "HCPCS"}, {"code": "72000921", "type": "CDM"}, {"code": "00517260225", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 28.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*MAGNESIUM SULF 2GM/100ML NS IVPB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3475", "type": "HCPCS"}, {"code": "72000756", "type": "CDM"}, {"code": "00517260225", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 28.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*NASAL TAMPONS", "code_information": [{"code": "3000242", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*NICODERM CQ (NICOTINE) PATCH 7MG/24HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000335", "type": "CDM"}, {"code": "00135019602", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*NICODERM CQ PATCH : 7MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000249", "type": "CDM"}, {"code": "00135019602", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*OXYGEN MASK ADULT", "code_information": [{"code": "3000234", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*OXYGEN MASK CHILD", "code_information": [{"code": "3000031", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*OXYGEN TUBING 25FT", "code_information": [{"code": "3001189", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*PISTON SYRN. 70CC", "code_information": [{"code": "3001190", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*POTASSIUM CHL 10MEQ/100ML WATER", "drug_information": {"unit": 5.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000957", "type": "CDM"}, {"code": "00338070948", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*POTASSIUM CHL 40MEQ IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000581", "type": "CDM"}, {"code": "63323096730", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "*SILVER NITRATE SWAB*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000423", "type": "CDM"}, {"code": "12165010003", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*SOAP", "code_information": [{"code": "3000042", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*SODIUM CHLORIDE .45% 500ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200015", "type": "CDM"}, {"code": "00338004304", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*SODIUM CHLORIDE 0.90% INHALANT AMP 3ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000507", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*TYLENOL (ACETAMINOPHEN) CAP : 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000471", "type": "CDM"}, {"code": "00045044980", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*URINE CONTAINER 24 HOUR", "code_information": [{"code": "3001379", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*VALIUM (DIAZEPAM) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000170", "type": "CDM"}, {"code": "00172392660", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*WATER IRR STER 500ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3000631", "type": "CDM"}, {"code": "00409613922", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*ZANAFLEX (TIZANIDINE CHL) TAB 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000591", "type": "CDM"}, {"code": "57664050389", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "*ZOCOR (SIMVASTATIN) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000498", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": ". SERUM FREE LIGHTCHAIN -ASSOC CHG", "code_information": [{"code": "83883", "type": "CPT"}, {"code": "1000789", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.64, "maximum": 169.88, "gross_charge": 188.76, "discounted_cash": 54.17, "estimated_discounted_cash": 188.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 169.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 107.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ". TELEMETRY OBSERVATION FEE PER HOUR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "10000016", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 34.43, "maximum": 2571.16, "gross_charge": 60.42, "discounted_cash": 54.17, "estimated_discounted_cash": 1541.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 48.33, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2571.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 54.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 34.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".ASSOC CHG HSV 1&2 IgM INDIVIDUAL", "code_information": [{"code": "86696", "type": "CPT"}, {"code": "1000791", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 22.25, "maximum": 103.11, "gross_charge": 114.57, "discounted_cash": 54.17, "estimated_discounted_cash": 114.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 91.65, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".CELIAC DISEASE AB RELATED CHARGE", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "1000549", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.7, "maximum": 49.54, "gross_charge": 55.05, "discounted_cash": 54.17, "estimated_discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".CELIAC DISEASE AB RELATED CHARGE", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "1000550", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 96.7, "gross_charge": 71.34, "discounted_cash": 54.17, "estimated_discounted_cash": 74.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".CREA/PROTEIN RATIO URINE -ASSOC CHG", "code_information": [{"code": "84156", "type": "CPT"}, {"code": "1000647", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.22, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "estimated_discounted_cash": 21.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".CRYPTOSPORIDIUM/ISOPORASMEAR ASSOCIATED", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "1000651", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 6.2, "maximum": 28.62, "gross_charge": 31.8, "discounted_cash": 54.17, "estimated_discounted_cash": 31.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 25.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 18.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".CULTURE STOOL ASSOCIATED CHARGE", "code_information": [{"code": "87046", "type": "CPT"}, {"code": "1000742", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.86, "maximum": 47.25, "gross_charge": 52.5, "discounted_cash": 54.17, "estimated_discounted_cash": 52.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".CULTURE STOOL ASSOCIATED CHARGE", "code_information": [{"code": "87427", "type": "CPT"}, {"code": "1000743", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.78, "maximum": 59.99, "gross_charge": 66.66, "discounted_cash": 54.17, "estimated_discounted_cash": 66.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 53.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 59.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 37.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".EBV TITER ASSOCIATED CHARGE", "code_information": [{"code": "86663", "type": "CPT"}, {"code": "1000744", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.09, "maximum": 96.7, "gross_charge": 73.35, "discounted_cash": 54.17, "estimated_discounted_cash": 73.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 58.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 66.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 41.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".EBV TITER ASSOCIATED CHARGE", "code_information": [{"code": "86664", "type": "CPT"}, {"code": "1000745", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 17.58, "maximum": 96.7, "gross_charge": 85.08, "discounted_cash": 54.17, "estimated_discounted_cash": 85.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.06, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 76.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 48.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".EBV TITER ASSOCIATED CHARGE", "code_information": [{"code": "86665", "type": "CPT"}, {"code": "1000746", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 20.86, "maximum": 96.7, "gross_charge": 100.89, "discounted_cash": 54.17, "estimated_discounted_cash": 100.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.71, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".EBV TITER ASSOCIATED CHARGE", "code_information": [{"code": "86665", "type": "CPT"}, {"code": "1000747", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 20.86, "maximum": 96.7, "gross_charge": 100.89, "discounted_cash": 54.17, "estimated_discounted_cash": 100.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.71, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".FEES TEST", "code_information": [{"code": "10000013", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": ".H PYLORI CULTURE RELATED CHARGE", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "1000548", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 4.91, "maximum": 23.08, "gross_charge": 25.26, "discounted_cash": 54.17, "estimated_discounted_cash": 25.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".INFLUENZA RAPID TEST A/B-ASSOCIATED", "code_information": [{"code": "87276", "type": "CPT"}, {"code": "1000631", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.48, "maximum": 63.9, "gross_charge": 71.01, "discounted_cash": 54.17, "estimated_discounted_cash": 71.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".IRN/TIBC ASSOCIATED CHARGE", "code_information": [{"code": "83550", "type": "CPT"}, {"code": "1000176", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.05, "maximum": 46.57, "gross_charge": 51.75, "discounted_cash": 54.17, "estimated_discounted_cash": 51.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 41.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 46.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".PROTEIN ELECTROPHORESIS URINE RANDOM AC", "code_information": [{"code": "84156", "type": "CPT"}, {"code": "1000765", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.22, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "estimated_discounted_cash": 21.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".PROTEIN/CREA RATIO URINE RDM-ASSOC CHG", "code_information": [{"code": "84156", "type": "CPT"}, {"code": "1000536", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.22, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "estimated_discounted_cash": 21.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".SPEP (EXPLODED CHG)", "code_information": [{"code": "84155", "type": "CPT"}, {"code": "1000017", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.22, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "estimated_discounted_cash": 21.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": ".STOOL O&P ASSOCIATED CHARGES", "code_information": [{"code": "87209", "type": "CPT"}, {"code": "1000768", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 20.68, "maximum": 87.73, "gross_charge": 79.0, "discounted_cash": 54.17, "estimated_discounted_cash": 79.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 BOD TEMP >=35.5", "code_information": [{"code": "G9773", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 BODYTEMP >=35.5CW/IN 30MIN", "code_information": [{"code": "4559F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 EM CORE SESSION", "code_information": [{"code": "G9873", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 MED VISIT IN 24MO", "code_information": [{"code": "G9247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 OR NO CT SINUS W/IN 90D DX", "code_information": [{"code": "G9354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "100 INSULIN SYRINGES", "code_information": [{"code": "S8490", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "12-LEAD ECG PERFORMED", "code_information": [{"code": "3120F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "17 ALPHA-HYDROXYPROGESTERONE", "code_information": [{"code": "83498", "type": "CPT"}, {"code": "1000623", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 31.25, "maximum": 144.72, "gross_charge": 160.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 128.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 91.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "17 KETOGENIC STEROIDS 24HR", "code_information": [{"code": "83582", "type": "CPT"}, {"code": "1000691", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.79, "maximum": 75.49, "gross_charge": 83.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 75.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "17 KETOGENIC/KETOSTEROIDS 24HR URINE", "code_information": [{"code": "83582", "type": "CPT"}, {"code": "1000692", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.79, "maximum": 75.49, "gross_charge": 83.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 75.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "17 KETOSTEROIDS 24HR URINE", "code_information": [{"code": "83586", "type": "CPT"}, {"code": "1000690", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.72, "maximum": 68.2, "gross_charge": 75.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 60.62, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "17-OH PROGESTERONE SERUM", "code_information": [{"code": "83498", "type": "CPT"}, {"code": "1000917", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 31.25, "maximum": 144.72, "gross_charge": 160.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 128.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 91.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "18 ALUM. MOP HEAD FRAME", "code_information": [{"code": "80000826", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "1DOSE MENIG VAC BTWN 11 & 13", "code_information": [{"code": "G9414", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST/SBSQ PSYC COLLAB CARE", "code_information": [{"code": "99494", "type": "CPT"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 NO WL", "code_information": [{"code": "G9877", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 NO WL", "code_information": [{"code": "G9876", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 19-21 WL", "code_information": [{"code": "G9884", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 22-24 WL", "code_information": [{"code": "G9885", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ ANTI-HYPRTNSV AGENTS TKN", "code_information": [{"code": "4145F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ ANTIPSY SCHIZ", "code_information": [{"code": "G0032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ BENZO SEIZ", "code_information": [{"code": "G0033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "20+ CC SYRINGE ONLY", "code_information": [{"code": "A4213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2019-nCOV PCR", "code_information": [{"code": "87635", "type": "CPT"}, {"code": "1001010", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 51.31, "maximum": 202.5, "gross_charge": 225.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 202.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D CEPHAL RADIO IMAGE", "code_information": [{"code": "D0702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D CEPHALOMETRIC IMAGE", "code_information": [{"code": "D0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 377.64, "maximum": 377.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 377.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D ORAL/FACIAL PHOTO IMAGE", "code_information": [{"code": "D0703", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [{"code": "C8924", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 COMP FOOT EXAM COMPLETED", "code_information": [{"code": "G9226", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3-D RADIOTHERAPY PLAN", "code_information": [{"code": "77295", "type": "CPT"}], "standard_charges": [{"minimum": 775.33, "maximum": 775.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 775.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D DENTAL SCAN DIRECT", "code_information": [{"code": "D0801", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D DENTAL SCAN INDIRECT", "code_information": [{"code": "D0802", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D FACIAL SCAN DIRECT", "code_information": [{"code": "D0803", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D FACIAL SCAN INDIRECT", "code_information": [{"code": "D0804", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D PRINT OF 3D SURFACE SCAN", "code_information": [{"code": "D0396", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76376", "type": "CPT"}], "standard_charges": [{"minimum": 30.81, "maximum": 30.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76377", "type": "CPT"}], "standard_charges": [{"minimum": 97.81, "maximum": 97.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 97.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D VOL IMG&RCNSTJ BRST/AX", "code_information": [{"code": "694T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy", "code_information": [{"code": "G0566", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D-CRT/IMRT RECEIVED", "code_information": [{"code": "4165F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obtained from previous diagnostic computed tomographic or magnetic resonance examination of the same anatomy", "code_information": [{"code": "C8001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4 EM CORE SESSIONS", "code_information": [{"code": "G9874", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "40-75Y W/TYPE 1/2 W/LDL-C RS", "code_information": [{"code": "G9676", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90649", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5 HIAA", "code_information": [{"code": "83497", "type": "CPT"}, {"code": "1000110", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.84, "maximum": 68.68, "gross_charge": 76.32, "discounted_cash": 54.17, "estimated_discounted_cash": 76.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE AND 0.45% SALINE", "code_information": [{"code": "S5010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE WITH POTASSIUM", "code_information": [{"code": "S5012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5% WL MAINTND FROM BSLINE WT", "code_information": [{"code": "G9888", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5%DEXTROSE/0.45%SALINE1000ML", "code_information": [{"code": "S5013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5+ CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FLD RTA PHOTO EVC RTNOPTHY", "code_information": [{"code": "2024F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FLD RTA PHOTO W/O RTNOPTHY", "code_information": [{"code": "2025F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9 EM CORE SESSIONS", "code_information": [{"code": "G9875", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9VHPV VACCINE 2/3 DOSE IM", "code_information": [{"code": "90651", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "<50% TOTAL PT OUTPT RA ENCTS", "code_information": [{"code": "M1008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "<6YR NEW ONSET HD ACHE", "code_information": [{"code": "G2193", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">55 YRS TEMP HD ACHE", "code_information": [{"code": "G2192", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED NOT ORD", "code_information": [{"code": "G9368", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED ORD", "code_information": [{"code": "G9367", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=2 SAME HI-RSK MED W/O DIAG", "code_information": [{"code": "M1209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=2 SAME MEDS TBL4 NOT ORD", "code_information": [{"code": "M1210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=50% TOTAL PT OUTPT RA ENCT", "code_information": [{"code": "M1007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=86Y NO HX COLO CA/RSN SCOP", "code_information": [{"code": "G9659", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified", "code_information": [{"code": "M1379", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A/D HALFWAY HOUSE, PER DIEM", "code_information": [{"code": "H2034", "type": "HCPCS"}], "standard_charges": [{"minimum": 1671.13, "maximum": 1671.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1671.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER DIEM", "code_information": [{"code": "H2036", "type": "HCPCS"}], "standard_charges": [{"minimum": 1671.13, "maximum": 1671.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1671.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER HOUR", "code_information": [{"code": "H2035", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AAC NON-ELECTRONIC BOARD", "code_information": [{"code": "E1902", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABCIXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABD IMAG W/US, CT OR MRI", "code_information": [{"code": "G9455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABD PAD STERILE SURG", "code_information": [{"code": "3000406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABILIFY (ARIPIPRAZOLE) 2MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002812", "type": "CDM"}, {"code": "67877043003", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABILIFY 5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002417", "type": "CDM"}, {"code": "65162089703", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABILIFY TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "7002206", "type": "CDM"}, {"code": "67877043203", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 49.61, "maximum": 78.33, "gross_charge": 87.04, "discounted_cash": 54.17, "estimated_discounted_cash": 30.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 65.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.63, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 345.0, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABO RH BLOOD TYPING DOCD", "code_information": [{"code": "3293F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}], "standard_charges": [{"minimum": 5637.45, "maximum": 5637.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}], "standard_charges": [{"minimum": 5637.45, "maximum": 5637.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}], "standard_charges": [{"minimum": 5637.45, "maximum": 5637.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 5637.45, "maximum": 5637.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ABOVE KNEE SURGICAL STOCKING", "code_information": [{"code": "A4490", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSCESS DRAINAGE UNDER X-RAY", "code_information": [{"code": "75989", "type": "CPT"}], "standard_charges": [{"minimum": 155.93, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 155.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG <= 16 SUC PUMP", "code_information": [{"code": "K0744", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG >16<=48 SUC PUMP", "code_information": [{"code": "K0745", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG >48 SUC PUMP", "code_information": [{"code": "K0746", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORPT DRG > 48 SQ IN W/BDR", "code_information": [{"code": "A6256", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT CROWN PORC TO TITANIUM", "code_information": [{"code": "D6097", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT RETAIN PORC TO TITANIUM", "code_information": [{"code": "D6195", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT CROWN TITANIUM", "code_information": [{"code": "D6094", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT RETAINER TITANI", "code_information": [{"code": "D6194", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED CROWN", "code_information": [{"code": "D6058", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6059", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6060", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6061", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6062", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6063", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6064", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6068", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6069", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6070", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6071", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6072", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6073", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6074", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABX PRES W/IN 10 DYS OF SYMP", "code_information": [{"code": "G9505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABX REG PRESCRIBED", "code_information": [{"code": "G9498", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AC5 WOUND SYSTEM", "code_information": [{"code": "A2020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACAMPROSATE CALCIUM TAB DR 333MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002440", "type": "CDM"}, {"code": "68462043518", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACAPatch, per square centimeter", "code_information": [{"code": "Q4325", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS OF TRANSEP CYTOL SAMP", "code_information": [{"code": "D0486", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACCUCHECK FINGERSTICK", "code_information": [{"code": "82948", "type": "CPT"}, {"code": "1000072", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.8, "maximum": 16.87, "gross_charge": 18.75, "discounted_cash": 54.17, "estimated_discounted_cash": 18.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCUPRIL (QUINAPRIL)TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000786", "type": "CDM"}, {"code": "59762502001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACCUPRIL (QUINAPRIL)TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000402", "type": "CDM"}, {"code": "43547041209", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACE ARB ARNI", "code_information": [{"code": "G2092", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE-I/ARB RX", "code_information": [{"code": "M1200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB NOT RX'D; DOC REAS", "code_information": [{"code": "G8474", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THERAPY RXD/TAKEN", "code_information": [{"code": "4010F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY FOR MOS/>", "code_information": [{"code": "4210F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY NOT RX'D", "code_information": [{"code": "G8475", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY RX'D", "code_information": [{"code": "G8473", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACESSO DL, PER SQ CM", "code_information": [{"code": "Q4293", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACESSO TL, PER SQ CM", "code_information": [{"code": "Q4300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETAMINOPHEN LEVEL", "code_information": [{"code": "80329", "type": "CPT"}, {"code": "1000137", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 107.81, "gross_charge": 119.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 95.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 107.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETATE CONC SOL PER GALLON", "code_information": [{"code": "A4708", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMID SODIUM INJECTIO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETIC ACID (NF-ACETIC ACID) IRRIG 0.25%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000841", "type": "CDM"}, {"code": "00264230410", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 37.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETYLCHOLINE RECEPTOR-BINDING ANTIBODIE", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "1000812", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.16, "maximum": 71.98, "gross_charge": 79.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}], "standard_charges": [{"minimum": 14.13, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}], "standard_charges": [{"minimum": 21.16, "maximum": 21.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}], "standard_charges": [{"minimum": 21.16, "maximum": 21.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}], "standard_charges": [{"minimum": 13.86, "maximum": 13.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0132", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACID CONC SOL PER GALLON", "code_information": [{"code": "A4709", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACIPHEX (RABERAZOLE SOD) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000347", "type": "CDM"}, {"code": "72888005930", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACP DISCUSS-NO DSCNMKR DOCD", "code_information": [{"code": "1124F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACP DISCUSS/DSCN MKR DOCD", "code_information": [{"code": "1123F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}], "standard_charges": [{"minimum": 37.51, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}], "standard_charges": [{"minimum": 100.0, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}], "standard_charges": [{"minimum": 90.0, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIGRAPHY TESTING", "code_information": [{"code": "95803", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}], "standard_charges": [{"minimum": 13.26, "maximum": 13.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVASE (ALTEPLASE) 100MG IV", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "72000374", "type": "CDM"}, {"code": "50242008527", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 267.21, "maximum": 22510.62, "gross_charge": 25011.81, "discounted_cash": 54.17, "estimated_discounted_cash": 12811.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18758.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20009.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22510.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14256.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIVASE (ALTEPLASE) 50MG IV", "drug_information": {"unit": 50.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "72004329", "type": "CDM"}, {"code": "50242008527", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 267.21, "maximum": 11529.99, "gross_charge": 12811.1, "discounted_cash": 54.17, "estimated_discounted_cash": 12811.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9608.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 10248.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 11529.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 7302.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIVATE MATRIX, PER SQ CM", "code_information": [{"code": "Q4301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVATED CARBON FILTER, EA", "code_information": [{"code": "A4680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVATED CHARCOAL W/SORBITOL LIQ 50GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000007", "type": "CDM"}, {"code": "51927449500", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 126.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTIVATED CHARCOAL W/SORBITOL LIQD 25GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000008", "type": "CDM"}, {"code": "51927449500", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 93.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTIVITY THERAPY, PER 15 MIN", "code_information": [{"code": "H2032", "type": "HCPCS"}], "standard_charges": [{"minimum": 550.81, "maximum": 550.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 550.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTOS (PIOGLITAZONE) TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000366", "type": "CDM"}, {"code": "00781542031", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 16.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTOS (PIOGLITAZONE) TAB 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000009", "type": "CDM"}, {"code": "57237022030", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 25.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACTOS (PIOGLITAZONE) TAB 45MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000356", "type": "CDM"}, {"code": "57237022130", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACULAR OPTH SOL 0.5% 0.4ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000575", "type": "CDM"}, {"code": "70512079005", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 39.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL 15 MIN", "code_information": [{"code": "97810", "type": "CPT"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL ADDL 15M", "code_information": [{"code": "97811", "type": "CPT"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL 15 MIN", "code_information": [{"code": "97813", "type": "CPT"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL ADDL 15M", "code_information": [{"code": "97814", "type": "CPT"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [{"code": "880", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "estimated_discounted_cash": 1290.6, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [{"code": "289", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [{"code": "288", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [{"code": "290", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CHRONIC OBSTRUCT", "code_information": [{"code": "G9681", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CONGESTIVE HEART", "code_information": [{"code": "G9680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE PNEUMONIA", "code_information": [{"code": "G9679", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE SKIN INFECTION", "code_information": [{"code": "G9682", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE URINARY TRACT INF", "code_information": [{"code": "G9684", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE FLUID/ELECTRO DISORDER", "code_information": [{"code": "G9683", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}], "standard_charges": [{"minimum": 414.37, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 414.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "835", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "834", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH OTHER PROCEDURES", "code_information": [{"code": "850", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "836", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [{"code": "121", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "122", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [{"code": "281", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [{"code": "280", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC", "code_information": [{"code": "282", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [{"code": "284", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [{"code": "283", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [{"code": "285", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE NURSING FACILITY CARE", "code_information": [{"code": "G9685", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE PVD", "code_information": [{"code": "M1337", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}], "standard_charges": [{"minimum": 374.18, "maximum": 374.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 374.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE VITREOUS HEMORRHAGE", "code_information": [{"code": "M1333", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR 1000MG/0.9% NS 250ML", "drug_information": {"unit": 200.0, "type": "EA"}, "code_information": [{"code": "J0133", "type": "HCPCS"}, {"code": "72004312", "type": "CDM"}, {"code": "55150015520", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 17.1, "maximum": 27.0, "gross_charge": 30.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}], "standard_charges": [{"minimum": 18.96, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}], "standard_charges": [{"minimum": 19.4, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADACEL (T-DAP) 0.5ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "90715", "type": "CPT"}, {"code": "72000432", "type": "CDM"}, {"code": "49281040020", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 57.62, "maximum": 90.99, "gross_charge": 101.1, "discounted_cash": 54.17, "estimated_discounted_cash": 159.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 75.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPT BEHAVIOR TX PHYS/QHP", "code_information": [{"code": "97155", "type": "CPT"}], "standard_charges": [{"minimum": 15.07, "maximum": 15.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT BHV TX EA 15 MIN", "code_information": [{"code": "373T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT PASTE", "code_information": [{"code": "3001132", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADAPT/EXT, PACING/NEURO LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTIVE BEHAVIOR TX BY TECH", "code_information": [{"code": "97153", "type": "CPT"}], "standard_charges": [{"minimum": 11.51, "maximum": 11.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD 30 MINS COUNSEL", "code_information": [{"code": "G2080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD CLASP TO PARTIAL DENTURE", "code_information": [{"code": "D5660", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD METAL SUB TO ACRYLC DENT", "code_information": [{"code": "D5876", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD PROC CONSTRUCT NEW CROWN", "code_information": [{"code": "D2971", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TOOTH TO PARTIAL DENTURE", "code_information": [{"code": "D5650", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDITIVE FOR ENTERAL FORMULA", "code_information": [{"code": "B4104", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SUPL MATRL&STAF TM PHE", "code_information": [{"code": "99072", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOMA DETECTED SCREENING", "code_information": [{"code": "3775F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOMA NOT DETECT SCREENING", "code_information": [{"code": "3776F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOSINE 6MG/2ML INJ", "drug_information": {"unit": 12.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "7000011", "type": "CDM"}, {"code": "63323065104", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 45.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}], "standard_charges": [{"minimum": 16.59, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}], "standard_charges": [{"minimum": 14.8, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}], "standard_charges": [{"minimum": 23.08, "maximum": 25.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHERE TX ASSESS AT LST ANN", "code_information": [{"code": "G8851", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESION BARRIER", "code_information": [{"code": "C1765", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIVE BANDAGE, FIRST-AID", "code_information": [{"code": "A6413", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIVE FOAM DRSG", "code_information": [{"code": "3000057", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADHESIVE REMOVER SKIN", "code_information": [{"code": "3001393", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADIT MDD DYS REM 12 MNTHS", "code_information": [{"code": "G9509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUNCTIVE PROCEDURE", "code_information": [{"code": "D9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUST MAX PROST APPLIANCE", "code_information": [{"code": "D5992", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.19, "maximum": 185.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 185.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUST SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9948", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUSTABLE CHAIR FOR ESRD PT", "code_information": [{"code": "E1570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUSTMENT GASTRIC BAND", "code_information": [{"code": "S2083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV HRMNL THXPY RXD", "code_information": [{"code": "4164F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV THXPYRXD/RCVD COLON CA", "code_information": [{"code": "4180F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV TRTMT CHEMO HER2", "code_information": [{"code": "G2206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS NO RS 12 MO", "code_information": [{"code": "M1020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS RS 12 PHQ<5", "code_information": [{"code": "M1019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADLT DISP UND/PULL ON ABV XL", "code_information": [{"code": "T4544", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV CHEMO 1ST HOME VISIT", "code_information": [{"code": "G0090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV DRUG 1ST HOME VISIT", "code_information": [{"code": "G0088", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV INFUSION DRUG IN HOME", "code_information": [{"code": "G0068", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM OF CHEMO DRUG IN HOME", "code_information": [{"code": "G0070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM OF SOC DTR ASSESS 5-15 M", "code_information": [{"code": "G0136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM SQ INFUSION DRUG IN HOME", "code_information": [{"code": "G0069", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM SUBQ DRUG 1ST HOME VISIT", "code_information": [{"code": "G0089", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 1ST", "code_information": [{"code": "M0249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 2ND", "code_information": [{"code": "M0250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN ECG CONTRAST AGENT", "code_information": [{"code": "93352", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "G0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 122.64, "maximum": 122.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN HOME SLEEP APNEA TEST", "code_information": [{"code": "D9956", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN INFLUENZA VIRUS VAC", "code_information": [{"code": "G0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 122.64, "maximum": 122.64, "discounted_cash": 54.17, "estimated_discounted_cash": 54.63, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION OF INFLUENZA VACCINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "90471", "type": "CPT"}, {"code": "7000518", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 31.13, "maximum": 122.64, "gross_charge": 54.63, "discounted_cash": 54.17, "estimated_discounted_cash": 174.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 43.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION OF PNEUMOCOCCAL VACCINE", "code_information": [{"code": "G0009", "type": "HCPCS"}, {"code": "7000517", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 31.13, "maximum": 122.64, "gross_charge": 54.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 43.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMISSION TO MCCM", "code_information": [{"code": "G9480", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ REMOV", "code_information": [{"code": "G9410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ SURG REV", "code_information": [{"code": "G9412", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [{"code": "90480", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADOPTIVE IMMUNOTHERAPY", "code_information": [{"code": "S2107", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADR DEP THRPY PRESCRIBED", "code_information": [{"code": "G9894", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}], "standard_charges": [{"minimum": 526.76, "maximum": 3077.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 526.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3077.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENAL TISSUE TRANSPLANT", "code_information": [{"code": "S2103", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENALIN (EPINEPHRINE(1:1000)1MG/ML INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J0169", "type": "HCPCS"}, {"code": "72000551", "type": "CDM"}, {"code": "63323069625", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 18.75, "maximum": 29.61, "gross_charge": 32.9, "discounted_cash": 54.17, "estimated_discounted_cash": 40.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 26.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 29.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENALIN (EPINEPHRINE) 1MG/10ML SYR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0169", "type": "HCPCS"}, {"code": "7000184", "type": "CDM"}, {"code": "76329331801", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 40.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENOCORTICOTROPIN HORMONE", "code_information": [{"code": "82024", "type": "CPT"}, {"code": "1000133", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 44.41, "maximum": 205.76, "gross_charge": 228.63, "discounted_cash": 54.17, "estimated_discounted_cash": 239.63, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 182.9, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 205.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 130.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT NO 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT PD OUT MAT PR 180 DYS TX", "code_information": [{"code": "M1035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT TKNG PHARMTHRY FOR OUD", "code_information": [{"code": "M1032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER 15M", "code_information": [{"code": "S5135", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER DIEM", "code_information": [{"code": "S5136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER DIEM", "code_information": [{"code": "S5102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER HALF DAY", "code_information": [{"code": "S5101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAYCARE SERVICES 15MIN", "code_information": [{"code": "S5100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DISP BRIEF/DIAP ABV XL", "code_information": [{"code": "T4543", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT FOSTER CARE PER DIEM", "code_information": [{"code": "S5140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT FOSTER CARE PER MONTH", "code_information": [{"code": "S5141", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER LG", "code_information": [{"code": "T4523", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER MED", "code_information": [{"code": "T4522", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER SM", "code_information": [{"code": "T4521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER XL", "code_information": [{"code": "T4524", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON LG", "code_information": [{"code": "T4527", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON MED", "code_information": [{"code": "T4526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON SM", "code_information": [{"code": "T4525", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON XL", "code_information": [{"code": "T4528", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SPEECH AID", "code_information": [{"code": "D5953", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV CARE HEART DX MVP", "code_information": [{"code": "G0055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV DEM CRGVR LIMITED", "code_information": [{"code": "G9917", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV RHEUM PT CARE MVP", "code_information": [{"code": "G0053", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVAIR DISKUS INH 250/50MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000012", "type": "CDM"}, {"code": "00054032756", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 291.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADVAIR DISKUS INH 500/50MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000759", "type": "CDM"}, {"code": "00173069500", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 445.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ADVANCED LIFE SUPPORT MILEAG", "code_information": [{"code": "A0390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVANCING CANCER CARE MVP", "code_information": [{"code": "M0001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNC CARE PLAN IN RCRD", "code_information": [{"code": "1157F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNC CARE PLAN TLK DOCD", "code_information": [{"code": "1158F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN 30 MIN", "code_information": [{"code": "99497", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN ADDL 30 MIN", "code_information": [{"code": "99498", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFB SMEAR/CULTURE BOTH SUSCEPT", "code_information": [{"code": "87015", "type": "CPT"}, {"code": "1000648", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.68, "maximum": 35.58, "gross_charge": 39.54, "discounted_cash": 54.17, "estimated_discounted_cash": 39.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}], "standard_charges": [{"minimum": 316.05, "maximum": 316.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFFINITY1 SQUARE CM", "code_information": [{"code": "Q4159", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFFIRM VAGINITIS SCREEN", "code_information": [{"code": "87480", "type": "CPT"}, {"code": "1000361", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 23.06, "maximum": 135.0, "gross_charge": 150.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFRIN (OXYMETAZOLINE) 0.05% NASAL SPRAY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000210", "type": "CDM"}, {"code": "00904742730", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITH CC/MCC", "code_information": [{"code": "949", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 13087.44, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "560", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 16432.42, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "561", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL IF", "code_information": [{"code": "87300", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE ANTIGEN", "code_information": [{"code": "86000", "type": "CPT"}], "standard_charges": [{"minimum": 8.03, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AGGRENOX (DIPYRIDAMOLE/ASA) CAP 25/200", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000348", "type": "CDM"}, {"code": "70436009205", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 9.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AHDL", "code_information": [{"code": "83718", "type": "CPT"}, {"code": "1000181", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.42, "maximum": 43.63, "gross_charge": 48.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 38.78, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 43.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AHI OR RDI INITIAL DX", "code_information": [{"code": "G8842", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 50-100 GEN ALG", "code_information": [{"code": "258U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD GENERATOR PROCEDURES", "code_information": [{"code": "245", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AICD LEAD PROCEDURES", "code_information": [{"code": "265", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AICD, DUAL CHAMBER", "code_information": [{"code": "C1721", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, OTHER THAN SING/DUAL", "code_information": [{"code": "C1882", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, SINGLE CHAMBER", "code_information": [{"code": "C1722", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR AMBULAN NONEMERG ROTARY", "code_information": [{"code": "S9961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR AMBULANC NONEMERG FIXED", "code_information": [{"code": "S9960", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR ELEVATOR FOR HEEL", "code_information": [{"code": "E0370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIRWAYS ORAL 5.0", "code_information": [{"code": "3001436", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAYS ORAL 7.0", "code_information": [{"code": "3001437", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAYS ORAL ADULT LG 9.0", "code_information": [{"code": "3000058", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAYS ORAL ADULT MED 8.0", "code_information": [{"code": "3000059", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAYS ORAL CHILD SM 6.0", "code_information": [{"code": "3000061", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWAYS ORAL INFANT 4.0", "code_information": [{"code": "3000062", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AIRWY RESIST BY OSCILLOMETRY", "code_information": [{"code": "94728", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG I: T1 MIC/T1A", "code_information": [{"code": "G9704", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG IB", "code_information": [{"code": "G9705", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 0 DOCD", "code_information": [{"code": "3370F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 1 DOCD", "code_information": [{"code": "3372F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 1 DOCD", "code_information": [{"code": "3374F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 2 DOCD", "code_information": [{"code": "3376F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 3 DOCD", "code_information": [{"code": "3378F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 4 DOCD", "code_information": [{"code": "3380F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 0 DOCD", "code_information": [{"code": "3382F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 1 DOCD", "code_information": [{"code": "3384F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 2 DOCD", "code_information": [{"code": "3386F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 3 DOCD", "code_information": [{"code": "3388F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 4 DOCD", "code_information": [{"code": "3390F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CNCR 0/IA MELAN DOCD", "code_information": [{"code": "3321F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC MEL CNR STG 0 - IIC", "code_information": [{"code": "G8944", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC STAGE DOCD B/4 THXPY", "code_information": [{"code": "3300F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC STG BRT CA DX II OR III", "code_information": [{"code": "G9831", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALARM SYMP ASSESSED-1+ PRSNT", "code_information": [{"code": "1071F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALARM SYMP ASSESSED-ABSENT", "code_information": [{"code": "1070F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALATROFLOXACIN MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN) 100ML 25%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000949", "type": "CDM"}, {"code": "68982064301", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 112.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 50ML", "code_information": [{"code": "P9047", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 5%, 250 ML", "code_information": [{"code": "P9045", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN),5%, 50ML", "code_information": [{"code": "P9041", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}], "standard_charges": [{"minimum": 39.03, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN SERUM", "code_information": [{"code": "82040", "type": "CPT"}, {"code": "1000118", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.69, "maximum": 26.37, "gross_charge": 29.31, "discounted_cash": 54.17, "estimated_discounted_cash": 29.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN, URINE", "code_information": [{"code": "82043", "type": "CPT"}, {"code": "1000095", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.65, "maximum": 15.6, "gross_charge": 17.34, "discounted_cash": 54.17, "estimated_discounted_cash": 17.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 9.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7609", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL IPRATROP NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL SULF 0.021% 0.63MG/3ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003389", "type": "CDM"}, {"code": "00487030101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALBUTEROL SULF 0.042% 1.25MG/3ML NEB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001059", "type": "CDM"}, {"code": "76204001155", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALBUTEROL SULF 0.083% 2.5MG/3ML NEB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000016", "type": "CDM"}, {"code": "47335070354", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALBUTEROL SULF 0.5% 2.5MG/0.5ML NEB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001128", "type": "CDM"}, {"code": "00487990130", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALBUTEROL SULFATE SYRUP 2MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200042", "type": "CDM"}, {"code": "52959015306", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG ASSESS", "code_information": [{"code": "H0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 838.62, "maximum": 838.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 838.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG HOTLINE", "code_information": [{"code": "H0030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG INTERVEN", "code_information": [{"code": "H0022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG OUTREACH", "code_information": [{"code": "H0023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 838.62, "maximum": 838.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 838.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0003", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0004", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0005", "type": "HCPCS"}], "standard_charges": [{"minimum": 683.18, "maximum": 683.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 683.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0006", "type": "HCPCS"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0007", "type": "HCPCS"}], "standard_charges": [{"minimum": 541.85, "maximum": 541.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 541.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 973.08, "maximum": 973.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 973.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0018", "type": "HCPCS"}], "standard_charges": [{"minimum": 973.08, "maximum": 973.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 973.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0020", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.09, "maximum": 109.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 109.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG TRAINING", "code_information": [{"code": "H0021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL LEVEL", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "1000119", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 38.64, "maximum": 102.04, "gross_charge": 67.8, "discounted_cash": 54.17, "estimated_discounted_cash": 67.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.24, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL OR PEROXIDE PER PINT", "code_information": [{"code": "A4244", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL SWABS", "code_information": [{"code": "80000823", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALCOHOL WIPES PER BOX", "code_information": [{"code": "A4245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [{"code": "895", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG ABUSE SVC NOS", "code_information": [{"code": "H0047", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SCREENING", "code_information": [{"code": "H0049", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.86, "maximum": 76.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SERVICE 15 MIN", "code_information": [{"code": "H0050", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.86, "maximum": 76.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUB MISUSE ASSESS", "code_information": [{"code": "G2011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV 15-30MN", "code_information": [{"code": "G0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV >30 MIN", "code_information": [{"code": "G0397", "type": "HCPCS"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBSTANCE ABUSE SKIL", "code_information": [{"code": "T1012", "type": "HCPCS"}], "standard_charges": [{"minimum": 550.81, "maximum": 550.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 550.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 1OR 2", "code_information": [{"code": "80321", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 3/MORE", "code_information": [{"code": "80322", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD BLU TOOTH FM/DM RECEIVER", "code_information": [{"code": "V5286", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM ADAPT/BOOT COUPLIN", "code_information": [{"code": "V5289", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM AUD INPUT RECEIVER", "code_information": [{"code": "V5285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM EAR LEVEL RECEIVER", "code_information": [{"code": "V5284", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM RECEIVER, NOS", "code_information": [{"code": "V5287", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM SYSTEM BINAURAL", "code_information": [{"code": "V5282", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM SYSTEM, MONAURAL", "code_information": [{"code": "V5281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM TRANSMITTER ALD", "code_information": [{"code": "V5288", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FOR COCHLEAR IMPLANT", "code_information": [{"code": "V5273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD NECK, LOOP IND RECEIVER", "code_information": [{"code": "V5283", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD TELEPHONE AMPLIFIER", "code_information": [{"code": "V5268", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD TRANSMITTER MICROPHONE", "code_information": [{"code": "V5290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD UNSPECIFIED", "code_information": [{"code": "V5274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD, TV AMPLIFIER, ANY TYPE", "code_information": [{"code": "V5270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD, TV CAPTION DECODER", "code_information": [{"code": "V5271", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALDACTONE (SPIRONOLACTONE) 100MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001151", "type": "CDM"}, {"code": "60687048701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALDACTONE (SPIRONOLACTONE) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000435", "type": "CDM"}, {"code": "51079010320", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALDOLASE", "code_information": [{"code": "82085", "type": "CPT"}, {"code": "1000500", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.17, "maximum": 48.6, "gross_charge": 54.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 48.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE", "code_information": [{"code": "82088", "type": "CPT"}, {"code": "1000679", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 46.86, "maximum": 217.1, "gross_charge": 241.23, "discounted_cash": 54.17, "estimated_discounted_cash": 241.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 192.98, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 217.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 137.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 144.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 144.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALEFACEPT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0215", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALERT DEVICE, NOC", "code_information": [{"code": "A9280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALERTING DEVICE, ANY TYPE", "code_information": [{"code": "V5269", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALEVE (NAPROXEN) TAB 375MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000330", "type": "CDM"}, {"code": "65162018910", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALGINATE DRESSING > 48 SQ IN", "code_information": [{"code": "A6198", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0205", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCOSIDASE ALFA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALIGNER BODY LARGE", "code_information": [{"code": "3000265", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALKALINE PHOS ISOENZYME", "code_information": [{"code": "84080", "type": "CPT"}, {"code": "1000020", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 78.78, "gross_charge": 87.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 70.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALKALINE PHOSPHATASE", "code_information": [{"code": "84075", "type": "CPT"}, {"code": "1000191", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 27.56, "gross_charge": 30.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLDRESS 4 X 4", "code_information": [{"code": "3000407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLDRESS 6 X 6", "code_information": [{"code": "3000408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEGRA (FEXOFENADINE) TAB 180MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000017", "type": "CDM"}, {"code": "55111078430", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}], "standard_charges": [{"minimum": 8.99, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALLERGY PATCH TESTS", "code_information": [{"code": "95044", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLERGY/IMMUNOLOGY SS", "code_information": [{"code": "G0060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLEVYN LIFE FOAM 5X5", "code_information": [{"code": "3001414", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLEVYN LIFE FOAM SACRAL", "code_information": [{"code": "3001415", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 28.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}], "standard_charges": [{"minimum": 9.17, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}], "standard_charges": [{"minimum": 20.62, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLODERM", "code_information": [{"code": "Q4116", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGEN, PER CC", "code_information": [{"code": "Q4212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [{"code": "14", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALLOPURINOL TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000018", "type": "CDM"}, {"code": "00904704161", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLOPURINOL TAB 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000019", "type": "CDM"}, {"code": "00904657261", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4115", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4123", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN AC, 1 CM", "code_information": [{"code": "Q4141", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOWRAP DS OR DRY 1 SQ CM", "code_information": [{"code": "Q4150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA-1 ANTITRYPSIN", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "1000494", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.46, "maximum": 71.55, "gross_charge": 79.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1 ANTITRYPSIN - STOOL", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "1000809", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.46, "maximum": 71.55, "gross_charge": 79.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1 ANTITRYPSIN PHENOTYPE", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "1000829", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.46, "maximum": 71.55, "gross_charge": 79.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN PHENO", "code_information": [{"code": "82104", "type": "CPT"}], "standard_charges": [{"minimum": 16.63, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "1000477", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.29, "maximum": 89.37, "gross_charge": 99.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN AMNIOTIC", "code_information": [{"code": "82106", "type": "CPT"}], "standard_charges": [{"minimum": 19.55, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPHA-FETOPROTEIN L3", "code_information": [{"code": "82107", "type": "CPT"}], "standard_charges": [{"minimum": 74.07, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL FOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL URETHRAL SUPPOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS 1", "code_information": [{"code": "A0426", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS 2", "code_information": [{"code": "A0433", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS DEFIBRILLATION SUPPLIES", "code_information": [{"code": "A0392", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ESOPHAGEAL INTUB SUPPLS", "code_information": [{"code": "A0396", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS IV DRUG THERAPY SUPPLIES", "code_information": [{"code": "A0394", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ROUTINE DISPOSBLE SUPPLS", "code_information": [{"code": "A0398", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS1-EMERGENCY", "code_information": [{"code": "A0427", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALT", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "1000199", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.1, "maximum": 28.18, "gross_charge": 31.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 25.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 28.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALT LONG-TERM CNTRL MED RXD", "code_information": [{"code": "4144F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALTACE (RAMIPRIL) CAP 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001001", "type": "CDM"}, {"code": "65862047501", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALTACE (RAMIPRIL) CAP 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000021", "type": "CDM"}, {"code": "65862047601", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY NOT W/EXTRACTS", "code_information": [{"code": "D7321", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY W/EXTRACT 1-3", "code_information": [{"code": "D7311", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOLUS CLSD REDUC STBLZ TE", "code_information": [{"code": "D7771", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOLUS OPEN REDUCTION", "code_information": [{"code": "D7671", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOPLASTY W/ EXTRACTION", "code_information": [{"code": "D7310", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALVEOPLASTY W/O EXTRACTION", "code_information": [{"code": "D7320", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG 15 MIN", "code_information": [{"code": "95983", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG ADDL 15", "code_information": [{"code": "95984", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX CN NPGT PRGRMG", "code_information": [{"code": "95977", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX SP/PN NPGT W/PRGRM", "code_information": [{"code": "95972", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS NPGT W/O PRGRMG", "code_information": [{"code": "95970", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS SMPL CN NPGT PRGRMG", "code_information": [{"code": "95976", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALYS SMPL SP/PN NPGT W/PRGRM", "code_information": [{"code": "95971", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMALGAM 4 OR > SURFACES PERM", "code_information": [{"code": "D2161", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMALGAM ONE SURFACE PERMANEN", "code_information": [{"code": "D2140", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMALGAM THREE SURFACES PERMA", "code_information": [{"code": "D2160", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMALGAM TWO SURFACES PERMANE", "code_information": [{"code": "D2150", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMARYL (GLIMEPIRIDE) TAB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000023", "type": "CDM"}, {"code": "68084032601", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMBIEN (ZOLPIDEM TARTRATE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000025", "type": "CDM"}, {"code": "00904608261", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMBIEN CR (ZOLPIDEM TART) TAB 12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000155", "type": "CDM"}, {"code": "54868542601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SOFTWARE", "code_information": [{"code": "93784", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW A/R", "code_information": [{"code": "93788", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW I&R", "code_information": [{"code": "93790", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW REC ONLY", "code_information": [{"code": "93786", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBU BAG ADULT DISP", "code_information": [{"code": "3000063", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 85.02, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMBU BAG INFANT DISP", "code_information": [{"code": "3000064", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 51.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMBU BAG PED DISP", "code_information": [{"code": "3000065", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 168.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMBULANCE 02 LIFE SUSTAINING", "code_information": [{"code": "A0422", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULANCE RESPONSE/TREATMENT", "code_information": [{"code": "A0998", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULANCE WAITING 1/2 HR", "code_information": [{"code": "A0420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SETTING SUBSTANCE", "code_information": [{"code": "S9475", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY TRACTION DEVICE", "code_information": [{"code": "E0830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMCIL (AMPICILLIN) 1GM INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}, {"code": "7200057", "type": "CDM"}, {"code": "55150011310", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMCIL (AMPICILLIN) 2GM/250ML NS", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}, {"code": "72001009", "type": "CDM"}, {"code": "55150011420", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMIDATE 20MG/10ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200075", "type": "CDM"}, {"code": "72266014610", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMIFOSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0207", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.3, "maximum": 631.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMIKACIN IV 500MG/2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0278", "type": "HCPCS"}, {"code": "72000600", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.31, "maximum": 14.71, "gross_charge": 16.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 13.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINES VAGINAL FLUID QUAL", "code_information": [{"code": "82120", "type": "CPT"}], "standard_charges": [{"minimum": 6.89, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACID SINGLE QUAL", "code_information": [{"code": "82127", "type": "CPT"}], "standard_charges": [{"minimum": 16.31, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS MULT QUAL", "code_information": [{"code": "82128", "type": "CPT"}], "standard_charges": [{"minimum": 15.95, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUAN 6 OR MORE", "code_information": [{"code": "82139", "type": "CPT"}], "standard_charges": [{"minimum": 19.4, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUANT 2-5", "code_information": [{"code": "82136", "type": "CPT"}], "standard_charges": [{"minimum": 22.55, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS SINGLE QUANT", "code_information": [{"code": "82131", "type": "CPT"}], "standard_charges": [{"minimum": 26.43, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOLEVULINIC ACID HCL TOP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7308", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMINOLEVULINIC ACID, 10% GEL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7345", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMITIZA (LUBIPROSTONE) CAP 24MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000640", "type": "CDM"}, {"code": "00480413806", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMITRIPTYLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMMONIA", "code_information": [{"code": "82140", "type": "CPT"}, {"code": "1000125", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.76, "maximum": 77.62, "gross_charge": 86.25, "discounted_cash": 54.17, "estimated_discounted_cash": 43.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMMONIA AROMATIC INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000030", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMMONIA IN HOUSE", "code_information": [{"code": "82140", "type": "CPT"}, {"code": "1400016", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.76, "maximum": 39.33, "gross_charge": 43.71, "discounted_cash": 54.17, "estimated_discounted_cash": 43.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 34.96, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 39.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMMONIA TEST STRIPS", "code_information": [{"code": "A4774", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNICORE PRO+, PER SQ CM", "code_information": [{"code": "Q4299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNICORE PRO, PER SQ CM", "code_information": [{"code": "Q4298", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO OR BIODMATRIX, INJ 1CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO OR DERMA TL, PER SQ CM", "code_information": [{"code": "Q4225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO QUAD-CORE, PER SQ CM", "code_information": [{"code": "Q4294", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO TRI-CORE, PER SQ CM", "code_information": [{"code": "Q4295", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO WOUND, PER SQUARE CM", "code_information": [{"code": "Q4181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO-MAXX OR LITE PER SQ CM", "code_information": [{"code": "Q4239", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOAMP-MP PER SQ CM", "code_information": [{"code": "Q4250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOARMOR 1 SQ CM", "code_information": [{"code": "Q4188", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND, 1 MG", "code_information": [{"code": "Q4168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND, GUARDIAN 1 SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS DIAGNOSTIC", "code_information": [{"code": "59000", "type": "CPT"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS THERAPEUTIC", "code_information": [{"code": "59001", "type": "CPT"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCORE PER SQ CM", "code_information": [{"code": "Q4227", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOCYTE PLUS, PER 0.5 CC", "code_information": [{"code": "Q4242", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOEXCEL BIODEXCEL 1SQ CM", "code_information": [{"code": "Q4137", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNION BIO OR AXOBIO SQ CM", "code_information": [{"code": "Q4211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOREPAIR OR ALTIPLY SQ CM", "code_information": [{"code": "Q4235", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTEXT PATCH, PER SQ CM", "code_information": [{"code": "Q4247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTEXT, PER CC", "code_information": [{"code": "Q4245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC FLUID SCAN", "code_information": [{"code": "82143", "type": "CPT"}], "standard_charges": [{"minimum": 10.75, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC MEMBRANE", "code_information": [{"code": "V2790", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOWRAP2 PER SQ CM", "code_information": [{"code": "Q4221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIPLY, PER SQ CM", "code_information": [{"code": "Q4249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNT PAIN NOTED NONE PRSNT", "code_information": [{"code": "1126F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNT PAIN NOTED PAIN PRSNT", "code_information": [{"code": "1125F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOBARBITAL 125 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOX W/WO CLAV RX", "code_information": [{"code": "G9315", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOXIC NOT PRESC AS 1ST LINE", "code_information": [{"code": "G9313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOXICILLIN INJ : 250MG/5ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000036", "type": "CDM"}, {"code": "55370088780", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMOXICILLIN TRIHYDRATE CAP 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000031", "type": "CDM"}, {"code": "00781202001", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMOXICILLIN TRIHYDRATE CAP : 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000033", "type": "CDM"}, {"code": "63304065501", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMOXICILLIN TRIHYDRATE SUSP 125MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000034", "type": "CDM"}, {"code": "00781603946", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMOXICILLIN TRIHYDRATE SUSP 250MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000035", "type": "CDM"}, {"code": "00143988980", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AMPHETAMINES 3OR 4", "code_information": [{"code": "80325", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 5 OR MORE", "code_information": [{"code": "80326", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHO B CHOLESTERYL SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0288", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPID COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0287", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 1GM/100ML NS", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}, {"code": "72001076", "type": "CDM"}, {"code": "55150011310", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27590", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27591", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27592", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LOWER LEG AT KNEE", "code_information": [{"code": "27598", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE METACARPAL BONE", "code_information": [{"code": "26910", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE UPPER ARM & IMPLANT", "code_information": [{"code": "24931", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24930", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25907", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25909", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25924", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25929", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25931", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27594", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27596", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27884", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27886", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [{"code": "240", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [{"code": "239", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC", "code_information": [{"code": "241", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "475", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "474", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "476", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26951", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26952", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27888", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27889", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25905", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25915", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF HAND", "code_information": [{"code": "25927", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27290", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27295", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27880", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27881", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "617", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "616", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "618", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF MIDFOOT", "code_information": [{"code": "28800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF TOE", "code_information": [{"code": "28820", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION THRU METATARSAL", "code_information": [{"code": "28805", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE & METATARSAL", "code_information": [{"code": "28810", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMYLASE", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "1000127", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.45, "maximum": 38.72, "gross_charge": 38.37, "discounted_cash": 54.17, "estimated_discounted_cash": 38.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 30.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANA CROWN EXP 1-3 PER QUAD", "code_information": [{"code": "D4231", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANA CROWN EXP 4 OR> PER QUAD", "code_information": [{"code": "D4230", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANA-IFA", "code_information": [{"code": "86038", "type": "CPT"}, {"code": "1000897", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.9, "maximum": 64.39, "gross_charge": 71.55, "discounted_cash": 54.17, "estimated_discounted_cash": 72.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.24, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 1 OR 2", "code_information": [{"code": "80327", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 3 OR MORE", "code_information": [{"code": "80328", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANACAULASE-BCDB 8.8% GEL 1 G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAEROBIC/AEROBIC CULTURE", "code_information": [{"code": "87075", "type": "CPT"}, {"code": "1000620", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.89, "maximum": 50.38, "gross_charge": 55.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 50.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAGRELIDE HCL CAP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000048", "type": "CDM"}, {"code": "00172524060", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [{"code": "348", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [{"code": "347", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "349", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ANAL PRESSURE RECORD", "code_information": [{"code": "91122", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51784", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALGESIA", "code_information": [{"code": "D9230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 3-5", "code_information": [{"code": "80330", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 6/MORE", "code_information": [{"code": "80331", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYSIS NERVE", "code_information": [{"code": "88356", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 267.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 267.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYSIS OF SALIVA SAMPLE", "code_information": [{"code": "D0418", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYSIS TUMOR", "code_information": [{"code": "88358", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 148.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 148.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYZE PACEMAKER SYSTEM", "code_information": [{"code": "93724", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYZE SP INF PUMP W/REPROG", "code_information": [{"code": "62368", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYZE SPINE INFUS PUMP", "code_information": [{"code": "62367", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAPLSMA PHGCYTOPHLM AMP PRB", "code_information": [{"code": "87468", "type": "CPT"}], "standard_charges": [{"minimum": 41.06, "maximum": 41.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1 MG", "code_information": [{"code": "S0170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANBX 30 PRIOR TO EPISODE", "code_information": [{"code": "G9703", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCA SCREEN EACH ANTIBODY", "code_information": [{"code": "86036", "type": "CPT"}], "standard_charges": [{"minimum": 13.86, "maximum": 13.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCA TITER EACH ANTIBODY", "code_information": [{"code": "86037", "type": "CPT"}], "standard_charges": [{"minimum": 13.86, "maximum": 13.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCEF (CEFAZOLIN SODIUM) 1GM INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0690", "type": "HCPCS"}, {"code": "72000535", "type": "CDM"}, {"code": "00143926225", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCEF 1GM/100ML 0.9% NS", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0690", "type": "HCPCS"}, {"code": "7000084", "type": "CDM"}, {"code": "00143926225", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR/SCREW BN/BN,TIS/BN", "code_information": [{"code": "C1713", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANDROLOGY INFERTILITY ASSMT", "code_information": [{"code": "255U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANDROSTANEDIOL GLUCURONIDE", "code_information": [{"code": "82154", "type": "CPT"}], "standard_charges": [{"minimum": 33.15, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANDROSTENEDIONE", "code_information": [{"code": "82157", "type": "CPT"}, {"code": "1000015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 33.67, "maximum": 155.95, "gross_charge": 173.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 138.62, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 155.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 98.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANEMIA PLAN OF CARE DOCD", "code_information": [{"code": "516F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES C HYST FLWG NEURAXIAL", "code_information": [{"code": "1969", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN DELIVERY ONLY", "code_information": [{"code": "1961", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN HYSTERECTOMY", "code_information": [{"code": "1963", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP CTRLD HYPOTENSION", "code_information": [{"code": "99135", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP EMERGENCY COND", "code_information": [{"code": "99140", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP TOT BDY HYPTHRM", "code_information": [{"code": "99116", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR CRV/THRC", "code_information": [{"code": "1937", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR LMBR/SAC", "code_information": [{"code": "1938", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DX SHOULDER ARTHROSCOPY", "code_information": [{"code": "1622", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES END, 1 TEMP >35.5(95.9)", "code_information": [{"code": "G9771", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR DIPHRG HRNA", "code_information": [{"code": "756", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR LMBR&VNT&/DEHS", "code_information": [{"code": "752", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR OMPHALOCELE", "code_information": [{"code": "754", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR UPR ABD NOS", "code_information": [{"code": "750", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES INCOMPL/MISSED AB PX", "code_information": [{"code": "1965", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES INDUCED ABORTION PX", "code_information": [{"code": "1966", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD GSTR PX MO", "code_information": [{"code": "797", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD LVR TRNSPL", "code_information": [{"code": "796", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD NOS", "code_information": [{"code": "790", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PNCRTECT", "code_information": [{"code": "794", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PRTL HPTC", "code_information": [{"code": "792", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST NDSC NOS", "code_information": [{"code": "811", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST SCR COLSC", "code_information": [{"code": "812", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES MEDIASCPY & DX THORSCPY", "code_information": [{"code": "528", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES MEDSCPY&THORSCPY 1 LUNG", "code_information": [{"code": "529", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT CRV/THRC", "code_information": [{"code": "1941", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT LMBR/SAC", "code_information": [{"code": "1942", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT CRV/THRC", "code_information": [{"code": "1939", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT LMBR/SAC", "code_information": [{"code": "1940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES PT EXTEME AGE<1 YR&>70", "code_information": [{"code": "99100", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES PX MAJ ABD BLOOD VESSEL", "code_information": [{"code": "770", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANSTHOR W/VENT", "code_information": [{"code": "626", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANTHOR W/O VENT", "code_information": [{"code": "625", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD ARTRL", "code_information": [{"code": "1924", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD CARD", "code_information": [{"code": "1925", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD TIPS", "code_information": [{"code": "1931", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD VEIN", "code_information": [{"code": "1930", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD CRAN VEIN", "code_information": [{"code": "1933", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD HRT/CRAN", "code_information": [{"code": "1926", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD TH VEIN", "code_information": [{"code": "1932", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX ERCP", "code_information": [{"code": "732", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX NOS", "code_information": [{"code": "731", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR LWR GI NDSC PX", "code_information": [{"code": "813", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES URGENT HYSTERECTOMY", "code_information": [{"code": "1962", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES VAGINAL DELIVERY ONLY", "code_information": [{"code": "1960", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES XTRNL CEPHALIC VERSION", "code_information": [{"code": "1958", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES/ANALG CS DLVR NEURAXIAL", "code_information": [{"code": "1968", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH 60 MIN/> AS DOCD", "code_information": [{"code": "4255F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMEN VESSEL SURG", "code_information": [{"code": "880", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "700", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "730", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "800", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "820", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ACHILLES TENDON SURG", "code_information": [{"code": "1472", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMNIOCENTESIS", "code_information": [{"code": "842", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT KNEE", "code_information": [{"code": "1404", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT PELVIS", "code_information": [{"code": "1140", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF FEMUR", "code_information": [{"code": "1232", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF PENIS", "code_information": [{"code": "932", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE REPLACEMENT", "code_information": [{"code": "1486", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE/FT ARTHROSCOPY", "code_information": [{"code": "1464", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ANORECTAL SURGERY", "code_information": [{"code": "902", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ARM-LEG VESSEL SURG", "code_information": [{"code": "1656", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ARTHROSCOPY OF HIP", "code_information": [{"code": "1202", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BICEPS TENDON REPAIR", "code_information": [{"code": "1716", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF NOSE", "code_information": [{"code": "164", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF THYROID", "code_information": [{"code": "322", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER STONE SURG", "code_information": [{"code": "870", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER SURGERY", "code_information": [{"code": "910", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER TUMOR SURG", "code_information": [{"code": "912", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEEDING CONTROL", "code_information": [{"code": "916", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEPHAROPLASTY", "code_information": [{"code": "103", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BODY CAST PROCEDURE", "code_information": [{"code": "1130", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BONE ASPIRATE/BX", "code_information": [{"code": "1112", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN 4-9 PERCENT", "code_information": [{"code": "1952", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN EACH 9 PERCENT", "code_information": [{"code": "1953", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN LESS 4 PERCENT", "code_information": [{"code": "1951", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/O PUMP", "code_information": [{"code": "566", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/PUMP", "code_information": [{"code": "567", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIAC ELECTROPHYS", "code_information": [{"code": "537", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIOVERTER/DEFIB", "code_information": [{"code": "534", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CAT OR MRI SCAN", "code_information": [{"code": "1922", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CATHETERIZE HEART", "code_information": [{"code": "1920", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST DRAINAGE", "code_information": [{"code": "524", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST LINING BIOPSY", "code_information": [{"code": "522", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST PROCEDURE", "code_information": [{"code": "520", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST SURGERY", "code_information": [{"code": "540", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST WALL REPAIR", "code_information": [{"code": "472", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CLEFT PALATE REPAIR", "code_information": [{"code": "172", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH COLLAR BONE BIOPSY", "code_information": [{"code": "454", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CORNEAL TRANSPLANT", "code_information": [{"code": "144", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CORRECT HEART RHYTHM", "code_information": [{"code": "410", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CRAN SURG HEMOTOMA", "code_information": [{"code": "211", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CRANIAL SURG NOS", "code_information": [{"code": "210", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ARTERIOGRAPHY", "code_information": [{"code": "1916", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ELBOW ARTHROSCOPY", "code_information": [{"code": "1732", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH DX KNEE ARTHROSCOPY", "code_information": [{"code": "1382", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH DX WRIST ARTHROSCOPY", "code_information": [{"code": "1829", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR EXAM", "code_information": [{"code": "124", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR SURGERY", "code_information": [{"code": "120", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW AREA SURGERY", "code_information": [{"code": "1710", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW REPLACEMENT", "code_information": [{"code": "1760", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ELECTROSHOCK", "code_information": [{"code": "104", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ESOPHAGEAL SURGERY", "code_information": [{"code": "500", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH EYE EXAM", "code_information": [{"code": "148", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FACE/SKULL BONE SURG", "code_information": [{"code": "190", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FACIAL BONE SURGERY", "code_information": [{"code": "192", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FAT LAYER REMOVAL", "code_information": [{"code": "802", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL ARTERY SURG", "code_information": [{"code": "1272", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL EMBOLECTOMY", "code_information": [{"code": "1274", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FOR LIVER BIOPSY", "code_information": [{"code": "702", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FOREQUARTER AMPUT", "code_information": [{"code": "1636", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FX REPAIR PELVIS", "code_information": [{"code": "1173", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH GENITALIA SURGERY", "code_information": [{"code": "920", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD NERVE SURGERY", "code_information": [{"code": "222", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD VESSEL SURGERY", "code_information": [{"code": "216", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD/NECK/PTRUNK", "code_information": [{"code": "300", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG <1 YR", "code_information": [{"code": "561", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/ARREST", "code_information": [{"code": "563", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/O PUMP", "code_information": [{"code": "560", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART/LUNG TRANSPLNT", "code_information": [{"code": "580", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR < 1 YR", "code_information": [{"code": "834", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR PREEMIE", "code_information": [{"code": "836", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP ARTHROPLASTY", "code_information": [{"code": "1214", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP DISARTICULATION", "code_information": [{"code": "1212", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT PROCEDURE", "code_information": [{"code": "1200", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT SURGERY", "code_information": [{"code": "1210", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HRT SURG W/PMP AGE 1+", "code_information": [{"code": "562", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERAL LESION SURG", "code_information": [{"code": "1758", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERUS REPAIR", "code_information": [{"code": "1744", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERUS SURGERY", "code_information": [{"code": "1742", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTERECTOMY", "code_information": [{"code": "846", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTEROSCOPE/GRAPH", "code_information": [{"code": "952", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH INSERT PENIS DEVICE", "code_information": [{"code": "938", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH INTRCRN NERVE", "code_information": [{"code": "220", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH IRIDECTOMY", "code_information": [{"code": "147", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY STONE DESTRUCT", "code_information": [{"code": "872", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY STONE DESTRUCT", "code_information": [{"code": "873", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY TRANSPLANT", "code_information": [{"code": "868", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY/URETER SURG", "code_information": [{"code": "862", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1340", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1390", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1320", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1360", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1392", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERIES SURG", "code_information": [{"code": "1440", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY REPAIR", "code_information": [{"code": "1444", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY SURG", "code_information": [{"code": "1442", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTHROPLASTY", "code_information": [{"code": "1402", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT CASTING", "code_information": [{"code": "1420", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT PROCEDURE", "code_information": [{"code": "1380", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT SURGERY", "code_information": [{"code": "1400", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VEINS SURGERY", "code_information": [{"code": "1430", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VESSEL SURG", "code_information": [{"code": "1432", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LARYNX/TRACH < 1 YR", "code_information": [{"code": "326", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LEG ARTERIES SURG", "code_information": [{"code": "1500", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LENS SURGERY", "code_information": [{"code": "142", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM CASTING", "code_information": [{"code": "1860", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM PROCEDURE", "code_information": [{"code": "1820", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1810", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1830", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM VEIN SURG", "code_information": [{"code": "1850", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG BONE SURG", "code_information": [{"code": "1480", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG CASTING", "code_information": [{"code": "1490", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG PROCEDURE", "code_information": [{"code": "1462", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG REVISION", "code_information": [{"code": "1484", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG SURGERY", "code_information": [{"code": "1470", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG SURGERY", "code_information": [{"code": "1474", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1520", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1522", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LUMBAR PUNCTURE", "code_information": [{"code": "635", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LUNG CHEST WALL SURG", "code_information": [{"code": "546", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM ARTERY SURG", "code_information": [{"code": "1840", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM EMBOLECTOMY", "code_information": [{"code": "1842", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM VEIN REPAIR", "code_information": [{"code": "1852", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR LEG EMBOLECTOMY", "code_information": [{"code": "1502", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH MAJOR VEIN LIGATION", "code_information": [{"code": "882", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH N BLOCK/INJ PRONE", "code_information": [{"code": "1992", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK ORGAN 1YR/>", "code_information": [{"code": "320", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "350", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "352", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NERVE BLOCK/INJ", "code_information": [{"code": "1991", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NOSE/SINUS SURGERY", "code_information": [{"code": "160", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH NOSE/SINUS SURGERY", "code_information": [{"code": "162", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ONE LUNG VENTILATION", "code_information": [{"code": "541", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PACEMAKER INSERTION", "code_information": [{"code": "530", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC ORGAN SURG", "code_information": [{"code": "848", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC TUMOR SURGERY", "code_information": [{"code": "1150", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS PROCEDURE", "code_information": [{"code": "1160", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1120", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1170", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "844", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "934", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "936", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PERINEAL SURGERY", "code_information": [{"code": "904", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "174", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "176", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON FEMUR", "code_information": [{"code": "1220", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON MOUTH", "code_information": [{"code": "170", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURES ON EYE", "code_information": [{"code": "140", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL FEMUR SURG", "code_information": [{"code": "1234", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL HUMERUS SURG", "code_information": [{"code": "1756", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL LEG SURGERY", "code_information": [{"code": "1482", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF ADRENAL", "code_information": [{"code": "866", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF BLADDER", "code_information": [{"code": "864", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF NERVES", "code_information": [{"code": "632", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "865", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "908", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "914", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF RIB", "code_information": [{"code": "470", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "926", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "928", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF VULVA", "code_information": [{"code": "906", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CERVIX", "code_information": [{"code": "948", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CLEFT LIP", "code_information": [{"code": "102", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "830", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "832", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REVISE HIP REPAIR", "code_information": [{"code": "1215", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SALIVARY GLAND", "code_information": [{"code": "100", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER ARTERY SURG", "code_information": [{"code": "1650", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER CASTING", "code_information": [{"code": "1680", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER JOINT AMPUT", "code_information": [{"code": "1634", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER PROCEDURE", "code_information": [{"code": "1620", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER REPLACEMENT", "code_information": [{"code": "1638", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VEIN SURG", "code_information": [{"code": "1670", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1652", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1654", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SITTING PROCEDURE", "code_information": [{"code": "604", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKIN EXT/PER/ATRUNK", "code_information": [{"code": "400", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "212", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "214", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL REPAIR/FRACT", "code_information": [{"code": "215", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPECIAL HEAD SURGERY", "code_information": [{"code": "218", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPERM DUCT SURGERY", "code_information": [{"code": "922", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "600", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "620", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "630", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "670", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE MANIPULATION", "code_information": [{"code": "640", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH STERNAL DEBRIDEMENT", "code_information": [{"code": "550", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH STONE REMOVAL", "code_information": [{"code": "918", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG LOWER ABDOMEN", "code_information": [{"code": "840", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG ON VAG/URETHRAL", "code_information": [{"code": "942", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF ABDOMEN", "code_information": [{"code": "860", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "402", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "404", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "406", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF FEMUR", "code_information": [{"code": "1230", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF RIB", "code_information": [{"code": "474", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1610", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1630", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "450", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "estimated_discounted_cash": 1066.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS EXPLORATION", "code_information": [{"code": "924", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS SUSPENSION", "code_information": [{"code": "930", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH THIGH ARTERIES SURG", "code_information": [{"code": "1270", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TRACH-BRONCH RECONST", "code_information": [{"code": "539", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TRACHEA BRONCHI SURG", "code_information": [{"code": "548", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TUBAL LIGATION", "code_information": [{"code": "851", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH TYMPANOTOMY", "code_information": [{"code": "126", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER ARM SURGERY", "code_information": [{"code": "1740", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER ARM VEIN SURG", "code_information": [{"code": "1780", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG SURGERY", "code_information": [{"code": "1250", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG VEINS SURG", "code_information": [{"code": "1260", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM ARTERY SURG", "code_information": [{"code": "1770", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM EMBOLECTOMY", "code_information": [{"code": "1772", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM PROCEDURE", "code_information": [{"code": "1730", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1712", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1714", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM VEIN REPAIR", "code_information": [{"code": "1782", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL ENDOSCOPY", "code_information": [{"code": "950", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL HYSTERECTOMY", "code_information": [{"code": "944", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL PROCEDURES", "code_information": [{"code": "940", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR ACCESS", "code_information": [{"code": "532", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR SHUNT SURG", "code_information": [{"code": "1844", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VASECTOMY", "code_information": [{"code": "921", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH VITREORETINAL SURG", "code_information": [{"code": "145", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH W/O GEN/NEURAX ANESTH", "code_information": [{"code": "4560F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH WRIST REPLACEMENT", "code_information": [{"code": "1832", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHE <60 MIN AS DOCD", "code_information": [{"code": "4256F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESIA REMOVAL PLEURA", "code_information": [{"code": "542", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESIOLOGY SS", "code_information": [{"code": "G0061", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGINA ABSENT", "code_information": [{"code": "1012F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGINA PECTORIS", "code_information": [{"code": "311", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ANGINA PRESENT", "code_information": [{"code": "1011F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIO FEM/POP W/ US", "code_information": [{"code": "C7531", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIO W/ US NON-CORONARY", "code_information": [{"code": "C7532", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOSCOPY", "code_information": [{"code": "35400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOTENSEN CONVERTING ENZYME", "code_information": [{"code": "82164", "type": "CPT"}, {"code": "1000322", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.79, "maximum": 77.76, "gross_charge": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.12, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANIDULAFUNGIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0348", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29891", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29892", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29894", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29895", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29897", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29898", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29899", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANL SP INF PMP W/MDREPRG&FIL", "code_information": [{"code": "62370", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANN BREAST EXAM", "code_information": [{"code": "S0613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL ALCOHOL SCREEN 15 MIN", "code_information": [{"code": "G0442", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.86, "maximum": 76.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL GYNECOLOGICAL EXAMINA", "code_information": [{"code": "S0610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL GYNECOLOGICAL EXAMINA", "code_information": [{"code": "S0612", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOGENITAL EXAM CHILD W IMAG", "code_information": [{"code": "99170", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANORO ELLIPTA INH. 62.5MCG/25MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002327", "type": "CDM"}, {"code": "00173086910", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46611", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND BIOPSY", "code_information": [{"code": "46606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND DILATION", "code_information": [{"code": "46604", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY CONTROL BLEEDING", "code_information": [{"code": "46614", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE FOR BODY", "code_information": [{"code": "46608", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESION", "code_information": [{"code": "46610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESIONS", "code_information": [{"code": "46612", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT RESIN-BASED CMPST CROWN", "code_information": [{"code": "D2390", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG I&R SPECLR MIC", "code_information": [{"code": "92286", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG IR FLRSCN ANGRPH", "code_information": [{"code": "92287", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG 8+", "code_information": [{"code": "22837", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG <7", "code_information": [{"code": "22836", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTB TP TOTAL&RPR IA QUAL", "code_information": [{"code": "64U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59426", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANAGEMENT", "code_information": [{"code": "H1001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANIPULATION", "code_information": [{"code": "59412", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTERIOR COLPORRHAPHY", "code_information": [{"code": "57240", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTERIOR GAIT TRAINER", "code_information": [{"code": "E8002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI CARDIOLIPIN AB Ig A/G/M QN", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "1000653", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 29.27, "maximum": 135.51, "gross_charge": 150.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 120.45, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 135.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI CARDIOLIPIN AB IgG", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "1000025", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 29.27, "maximum": 135.51, "gross_charge": 150.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 120.45, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 135.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI CARDIOLIPIN ANTIBODIES IGA", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "1000026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 29.27, "maximum": 135.51, "gross_charge": 150.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 120.45, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 135.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI CENTROMERE B ANTIBODIES", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "1000622", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.62, "maximum": 96.7, "gross_charge": 106.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.91, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI DNA SINGLE STRAND AB IGG", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "1099023", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.91, "maximum": 78.32, "gross_charge": 87.03, "discounted_cash": 54.17, "estimated_discounted_cash": 87.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI DOUBLE STRANDED ANTIBODIES", "code_information": [{"code": "86225", "type": "CPT"}, {"code": "1000058", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.8, "maximum": 73.19, "gross_charge": 81.33, "discounted_cash": 54.17, "estimated_discounted_cash": 92.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 65.06, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 73.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI GLIADIN ANTIBODIES IgG/IgA EIA", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "1000018", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.86, "maximum": 68.98, "gross_charge": 76.65, "discounted_cash": 54.17, "estimated_discounted_cash": 76.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI MICROSOMAL ANTIBODIES", "code_information": [{"code": "86376", "type": "CPT"}, {"code": "1000030", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.73, "maximum": 103.37, "gross_charge": 86.13, "discounted_cash": 54.17, "estimated_discounted_cash": 86.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.9, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI RHEUM DRUGTHXPYRXD/GVN", "code_information": [{"code": "4187F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI SCLERODERMA 70-ANTIBODIES", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "1000027", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.62, "maximum": 96.7, "gross_charge": 106.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.91, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI SMOOTH MUSCLE", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "1000307", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 96.7, "gross_charge": 71.34, "discounted_cash": 54.17, "estimated_discounted_cash": 71.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-CCP ANTIBODIES IgG/IgA", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000472", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-EGFR MON ANTI THER", "code_information": [{"code": "G9839", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-GM1 ANTIBODY", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000895", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-INFLM/ANLGSC AGENT RX", "code_information": [{"code": "4016F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-INFLM/ANLGSC OTC ASSESS", "code_information": [{"code": "1007F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7198", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-PHOSPHOLIPID ANTIBODY", "code_information": [{"code": "86148", "type": "CPT"}], "standard_charges": [{"minimum": 18.48, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTI-SMITH ANTIBODY", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "1000349", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.62, "maximum": 96.7, "gross_charge": 106.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.91, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBIO RX W IN 10D OF SYMPT", "code_information": [{"code": "G9286", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBIOT NOT RXD/GIVEN", "code_information": [{"code": "4124F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBIOT RXD/GIVEN", "code_information": [{"code": "4120F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBIOTIC NOT PRES", "code_information": [{"code": "G8708", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY DETECTION NOS IF", "code_information": [{"code": "87299", "type": "CPT"}], "standard_charges": [{"minimum": 18.52, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SARS-COV-2 TITER(S)", "code_information": [{"code": "224U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIBODY TEST PUB HLTH PATH", "code_information": [{"code": "D0605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICOAG CLINIC PER SESSION", "code_information": [{"code": "S9401", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICOAG MGMT PT WARFARIN", "code_information": [{"code": "93793", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICOAG THX RX AT DISCHRG", "code_information": [{"code": "4075F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTICONV THXPY FOR 6 MOS/>", "code_information": [{"code": "4230F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTID GLBLN RCVD W/IN 26WKS", "code_information": [{"code": "4178F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRES RXTHXPY NOT RXD", "code_information": [{"code": "4063F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT RX", "code_information": [{"code": "4064F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT TRICYCLIC 1/2", "code_information": [{"code": "80335", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT TRICYCLIC 3-5", "code_information": [{"code": "80336", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 3-5", "code_information": [{"code": "80333", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 6/MORE", "code_information": [{"code": "80334", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIDIURETIC HORMONE PROFILE", "code_information": [{"code": "83930", "type": "CPT"}, {"code": "1000898", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.6, "maximum": 40.5, "gross_charge": 45.0, "discounted_cash": 54.17, "estimated_discounted_cash": 45.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC DRUG ORAL NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8597", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC RECTAL/SUPP NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8498", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 4-6", "code_information": [{"code": "80340", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 7/MORE", "code_information": [{"code": "80341", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIFUNGAL OINTMENT 3.75oz", "code_information": [{"code": "3001110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTIFUNGAL POWDER", "code_information": [{"code": "3001122", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTIGEN TEST PUB HLTH PATHOG", "code_information": [{"code": "D0604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95144", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95145", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95146", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95147", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95148", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95149", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95165", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95170", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIGLOMERULAR BM Ab", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "1000816", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.86, "maximum": 68.98, "gross_charge": 76.65, "discounted_cash": 54.17, "estimated_discounted_cash": 76.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIHEMOPHILIC VIII/VWF COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7186", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIHIST/DECONG RX/RECOM", "code_information": [{"code": "4133F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIHISTONE ANTIBODIES", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "1000901", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.62, "maximum": 96.7, "gross_charge": 106.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.91, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTINEUTROPHIL CYTOPLASMIC Ab", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "1000498", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 96.7, "gross_charge": 71.34, "discounted_cash": 54.17, "estimated_discounted_cash": 71.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTINOMYCES ANTIBODY", "code_information": [{"code": "86602", "type": "CPT"}], "standard_charges": [{"minimum": 11.71, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTINUCLEAR ANTIBODIES (ANA)", "code_information": [{"code": "86039", "type": "CPT"}], "standard_charges": [{"minimum": 12.83, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTINUCLEAR ANTIBODIES COMP PROF PLUS", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000906", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIPANCREATIC ISLET CELLS", "code_information": [{"code": "86341", "type": "CPT"}, {"code": "1000855", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 27.11, "maximum": 105.4, "gross_charge": 117.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 93.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 105.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 66.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIPARIETAL CELL ANTIBODY", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000673", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTIC RX", "code_information": [{"code": "4065F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 4-6", "code_information": [{"code": "80343", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 7/MORE", "code_information": [{"code": "80344", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTISPERM ANTIBODIES TEST", "code_information": [{"code": "S3655", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.7, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTISTREPTOLYSIN O SCREEN", "code_information": [{"code": "86063", "type": "CPT"}], "standard_charges": [{"minimum": 6.64, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ACTIVITY", "code_information": [{"code": "85300", "type": "CPT"}, {"code": "1000533", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.63, "maximum": 63.12, "gross_charge": 70.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.11, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 39.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ANTIGEN", "code_information": [{"code": "85301", "type": "CPT"}], "standard_charges": [{"minimum": 12.43, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7197", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7196", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHYMOCYTE GLOBULN RABBIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTITHYROGLOBULIN ANTIBODY", "code_information": [{"code": "86800", "type": "CPT"}, {"code": "1000621", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 18.3, "maximum": 103.37, "gross_charge": 94.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 75.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 84.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 53.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIVENIN LATRODECTUS MACTANS INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000039", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 55.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTIVERT (MECLIZINE HCL) TAB 12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000306", "type": "CDM"}, {"code": "50268052215", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTIVERT (MECLIZINE) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000307", "type": "CDM"}, {"code": "60687073065", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT 1ST GD", "code_information": [{"code": "561T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT EA ADDL", "code_information": [{"code": "562T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT 1ST CMPNT", "code_information": [{"code": "559T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT EA ADDL", "code_information": [{"code": "560T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANUCORT (HYDROCORTISONE) SUPP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000040", "type": "CDM"}, {"code": "16571067621", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANUSOL (HYDROCORTISONE) 2.5% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000041", "type": "CDM"}, {"code": "69315031228", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ANY HYGIENIC ITEM, DEVICE", "code_information": [{"code": "A9286", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AOR ANE 5.5-5.9 CM MAX DIAM", "code_information": [{"code": "G9598", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AOR ANE >=6.0 CM MAX DIAM", "code_information": [{"code": "G9599", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [{"code": "268", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [{"code": "269", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AORTIC ANEURYSM 5-5.4CM DIAM", "code_information": [{"code": "9002F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC ANEURYSM<5CM DIAM CT", "code_information": [{"code": "9001F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC ANRYSM 6/> CM DIAM", "code_information": [{"code": "9004F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC ANRYSM5.5-5.9CM DIAM", "code_information": [{"code": "9003F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33970", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33971", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81410", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 579.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81411", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 1552.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1552.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC HEMIARCH GRAFT", "code_information": [{"code": "33866", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 230.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 230.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 897.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APC GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81202", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 322.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APC MRNA SEQ ALYS", "code_information": [{"code": "157U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC FINAL", "code_information": [{"code": "D3353", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC INITIAL", "code_information": [{"code": "D3351", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC INTERIM", "code_information": [{"code": "D3352", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHAKIA PROSTH SERVICE TEMP", "code_information": [{"code": "92358", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS IMMUNOADS SLCTV", "code_information": [{"code": "36516", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS RBC", "code_information": [{"code": "36512", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHERESIS WBC", "code_information": [{"code": "36511", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APHLX TO VAX BEF ENC", "code_information": [{"code": "M1311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APICALLY POSITIONED FLAP", "code_information": [{"code": "D4245", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APICOECTOMY - ANTERIOR", "code_information": [{"code": "D3410", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APIDRA (INSULIN GLULISINE) 100U/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "7001336", "type": "CDM"}, {"code": "00088250033", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APIS, PER SQUARE CENTIMETER", "code_information": [{"code": "A2010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APLIGRAF", "code_information": [{"code": "Q4101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APOL1 RISK VARIANTS", "code_information": [{"code": "355U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APOLIPOPROTEIN B", "code_information": [{"code": "82172", "type": "CPT"}, {"code": "1000470", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 24.25, "maximum": 126.0, "gross_charge": 140.0, "discounted_cash": 54.17, "estimated_discounted_cash": 140.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOMORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+CNTRST BTH EA 15", "code_information": [{"code": "97034", "type": "CPT"}], "standard_charges": [{"minimum": 13.76, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+HUBBRD TNK EA 15", "code_information": [{"code": "97036", "type": "CPT"}], "standard_charges": [{"minimum": 31.49, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+IONTPHRSIS EA 15", "code_information": [{"code": "97033", "type": "CPT"}], "standard_charges": [{"minimum": 18.47, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 96.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+ULTRASOUND EA 15", "code_information": [{"code": "97035", "type": "CPT"}], "standard_charges": [{"minimum": 13.46, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 46.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX 1ST", "code_information": [{"code": "20696", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX XCH", "code_information": [{"code": "20697", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP OF HYDROXYAPATITE", "code_information": [{"code": "D2991", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APP TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "99188", "type": "CPT"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44950", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44960", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY ADD-ON", "code_information": [{"code": "44955", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDICO-VESICOSTOMY", "code_information": [{"code": "50845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH CC", "code_information": [{"code": "398", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH MCC", "code_information": [{"code": "397", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "399", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "APPL DESENSITIZING RESIN", "code_information": [{"code": "D9911", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL HALO CRANIAL 6+PINS", "code_information": [{"code": "20664", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [{"code": "20692", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+ESTIM EA 15", "code_information": [{"code": "97032", "type": "CPT"}], "standard_charges": [{"minimum": 13.91, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 52.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+LLLT PO PAIN", "code_information": [{"code": "97037", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL MULTLAY COMPRS ARM/HAND", "code_information": [{"code": "29584", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL SHRT LEG SPLNT CALF-FOOT (TECH)", "code_information": [{"code": "29515", "type": "CPT"}, {"code": "11000002", "type": "CDM"}, {"code": "981", "type": "RC"}], "standard_charges": [{"minimum": 138.66, "maximum": 365.63, "gross_charge": 406.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 304.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 325.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 365.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 231.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL SLVR DIAMN FLUORIDE 38%", "code_information": [{"code": "792T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [{"code": "20690", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLIANCE REMOVAL", "code_information": [{"code": "D7997", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLIC FINGER SPLINT TECH", "code_information": [{"code": "29130", "type": "CPT"}, {"code": "11000004", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 95.69, "maximum": 151.09, "gross_charge": 167.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 151.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 95.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLIC FOREARM SPLINT", "code_information": [{"code": "29126", "type": "CPT"}, {"code": "11000011", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 138.66, "maximum": 280.9, "gross_charge": 312.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 234.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 249.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 280.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 177.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLIC LONG ARM CAST SHOULDER-ARM (TECH)", "code_information": [{"code": "29065", "type": "CPT"}, {"code": "11000005", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 405.74, "maximum": 640.65, "gross_charge": 711.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 533.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 569.47, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 640.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 405.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLIC LONG LEG CAST THIGH-TOES (TECH)", "code_information": [{"code": "29345", "type": "CPT"}, {"code": "11000006", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 405.74, "maximum": 640.65, "gross_charge": 711.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 533.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 569.47, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 640.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 405.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLIC LONG LEG SLNT THIGH-TOES (TECH)", "code_information": [{"code": "29505", "type": "CPT"}, {"code": "11000018", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 138.66, "maximum": 365.63, "gross_charge": 406.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 304.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 325.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 365.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 231.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLIC OF LONG ARM SPLINT (TECH)", "code_information": [{"code": "29105", "type": "CPT"}, {"code": "11000019", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 138.66, "maximum": 365.63, "gross_charge": 406.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 304.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 325.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 365.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 231.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLIC SHORT ARM SPLINT (TECH)", "code_information": [{"code": "29125", "type": "CPT"}, {"code": "11000007", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 138.66, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLIC SHRT ARM CAST ELBOW-FINGER (TECH)", "code_information": [{"code": "29075", "type": "CPT"}, {"code": "11000008", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 405.74, "maximum": 640.65, "gross_charge": 711.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 533.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 569.47, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 640.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 405.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLIC SHRT LEG CAST KNEE-TOES (TECH)", "code_information": [{"code": "29405", "type": "CPT"}, {"code": "11000009", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 405.74, "maximum": 640.65, "gross_charge": 711.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 533.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 569.47, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 640.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 405.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO CRANIAL", "code_information": [{"code": "20661", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO FEMORAL", "code_information": [{"code": "20663", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO PELVIC", "code_information": [{"code": "20662", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29000", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29010", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29015", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29035", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29040", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29044", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29046", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FIGURE EIGHT", "code_information": [{"code": "29049", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29131", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CAST", "code_information": [{"code": "29305", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CASTS", "code_information": [{"code": "29325", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LEG CAST", "code_information": [{"code": "29450", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29355", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29365", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF PASTE BOOT", "code_information": [{"code": "29580", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29055", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29058", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATON ON-BODY INJECTOR", "code_information": [{"code": "96377", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATOR COT TIP STERILE", "code_information": [{"code": "3000410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLICATOR POLYESTER-TIPPED 6 STICK", "code_information": [{"code": "3001349", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLICATOR WOOD COT", "code_information": [{"code": "3000067", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APPLY FINGER CAST", "code_information": [{"code": "29086", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY HAND/WRIST CAST", "code_information": [{"code": "29085", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY INTERSTIT RADIAT COMPL", "code_information": [{"code": "77778", "type": "CPT"}], "standard_charges": [{"minimum": 1473.38, "maximum": 1473.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1473.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT COMPL", "code_information": [{"code": "77763", "type": "CPT"}], "standard_charges": [{"minimum": 1257.56, "maximum": 1257.56, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1257.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT INTERM", "code_information": [{"code": "77762", "type": "CPT"}], "standard_charges": [{"minimum": 890.72, "maximum": 890.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 890.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}], "standard_charges": [{"minimum": 674.47, "maximum": 674.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 674.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY LONG LEG CAST BRACE", "code_information": [{"code": "29358", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [{"code": "29581", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY REM FIXATION DEVICE", "code_information": [{"code": "20660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "29445", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29425", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29435", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY SURF LDR RADIONUCLIDE", "code_information": [{"code": "77789", "type": "CPT"}], "standard_charges": [{"minimum": 216.34, "maximum": 216.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 216.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPRO RAD DS DVCS TECHS DOCD", "code_information": [{"code": "6040F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP ACE/ARB TSTNG DONE", "code_information": [{"code": "4188F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP ANTICONVULS TSTNG", "code_information": [{"code": "4191F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP DIGOXIN TSTNG DONE", "code_information": [{"code": "4189F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP DIURETIC TSTNG DONE", "code_information": [{"code": "4190F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROP ORAL REHYD RECOMMD", "code_information": [{"code": "4056F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPROPOS MTHD OFFLOADING RXD", "code_information": [{"code": "4269F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APRESOLINE (HYDRALAZINE HCL) 20MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0360", "type": "HCPCS"}, {"code": "72000910", "type": "CDM"}, {"code": "63323061455", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 22.37, "maximum": 35.32, "gross_charge": 39.25, "discounted_cash": 54.17, "estimated_discounted_cash": 54.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APRESOLINE (HYDRALAZINE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000624", "type": "CDM"}, {"code": "00904744761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APRESOLINE (HYDRALAZINE) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000490", "type": "CDM"}, {"code": "00904744861", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APRESOLINE (HYDRALAZINE) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000229", "type": "CDM"}, {"code": "51079007620", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "APROTONIN, 10,000 KIU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 13.86, "maximum": 13.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQMBF PET REST & RX STRESS", "code_information": [{"code": "78434", "type": "CPT"}], "standard_charges": [{"minimum": 120.51, "maximum": 120.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 120.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQMBF SPECT XERS/STRS & REST", "code_information": [{"code": "742T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUACEL 6X6 DRESSING", "code_information": [{"code": "3001248", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.56, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB CBA EACH", "code_information": [{"code": "86052", "type": "CPT"}], "standard_charges": [{"minimum": 13.86, "maximum": 13.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB ELISA", "code_information": [{"code": "86051", "type": "CPT"}], "standard_charges": [{"minimum": 13.26, "maximum": 13.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY/EXERCISES", "code_information": [{"code": "97113", "type": "CPT"}], "standard_charges": [{"minimum": 34.67, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/GRAFT", "code_information": [{"code": "66180", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/O GRAFT", "code_information": [{"code": "66179", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AR FULL SEQUENCE ANALYSIS", "code_information": [{"code": "230U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AR GENE CHARAC ALLELES", "code_information": [{"code": "81204", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AR GENE FULL GENE SEQUENCE", "code_information": [{"code": "81173", "type": "CPT"}], "standard_charges": [{"minimum": 346.55, "maximum": 346.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 346.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AR GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81174", "type": "CPT"}], "standard_charges": [{"minimum": 212.98, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARAVA (LEFLUNOMIDE) 20MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001030", "type": "CDM"}, {"code": "23155004403", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARAVA (LEFLUNOMIDE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000768", "type": "CDM"}, {"code": "23155004303", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARBUTAMINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0395", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARCHITECT ECM PX FX 1 SQ CM", "code_information": [{"code": "Q4147", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARG II EXT COM/SUP/ACC MISC", "code_information": [{"code": "L8608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0892", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS, AUROMED", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0899", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN ESRD DIALYSIS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0884", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0891", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (AUROMED)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0898", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD USE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARICEPT (DONEPEZIL) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000043", "type": "CDM"}, {"code": "43547027509", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARIMIDEX (ANASTRAZOLE) TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000352", "type": "CDM"}, {"code": "60687011221", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 28.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE LAUROXIL 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1944", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARM SLING - CHILD", "code_information": [{"code": "3000069", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARM SLING - PEDIATRIC", "code_information": [{"code": "3000070", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARM SLING UNIV", "code_information": [{"code": "3001156", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARMBOARD ADULT LONG 3X18", "code_information": [{"code": "3000073", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARMBOARD ADULT SHORT 3X9", "code_information": [{"code": "3000072", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARMBOARD PEDIATRIC LONG 2X9", "code_information": [{"code": "3000074", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARMBOARD PEDIATRIC SHORT 2X6", "code_information": [{"code": "3000071", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.82, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARSENIC TRIOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9017", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AOR-CELIAC-MSN-RENAL", "code_information": [{"code": "35631", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORSUBCL/CAROT/INNOM", "code_information": [{"code": "35626", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBI-ILIAC", "code_information": [{"code": "35638", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBIFEMORAL", "code_information": [{"code": "35646", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOFEMORAL", "code_information": [{"code": "35647", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOILIAC", "code_information": [{"code": "35637", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILL-FEM-FEMORAL", "code_information": [{"code": "35654", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-AXILLARY", "code_information": [{"code": "35650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-FEMORAL", "code_information": [{"code": "35621", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-POP-TIBIAL", "code_information": [{"code": "35623", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-SUBCLAVIAN", "code_information": [{"code": "35606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35666", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-POPLITEAL", "code_information": [{"code": "35656", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": "35540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOFEMORAL", "code_information": [{"code": "35539", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRCHL-ULNR-RDL", "code_information": [{"code": "35523", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CONTRAL CAROTID", "code_information": [{"code": "35509", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT HEPATORENAL", "code_information": [{"code": "35535", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOFEMORAL", "code_information": [{"code": "35565", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOILIAC", "code_information": [{"code": "35563", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-AXILARY", "code_information": [{"code": "35516", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-VERTBRL", "code_information": [{"code": "35515", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-CELIAC", "code_information": [{"code": "35632", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOFEMORAL", "code_information": [{"code": "35665", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35571", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP TIBIAL-TIB/PERONEAL", "code_information": [{"code": "35570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART OR VENOUS BLOOD TUBING", "code_information": [{"code": "A4750", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PANCREAS EXT RECEIVER", "code_information": [{"code": "S1037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PANCREAS EXT TRANSMITTER", "code_information": [{"code": "S1036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PANCREAS INV DISP SENSOR", "code_information": [{"code": "S1035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PANCREAS SYSTEM", "code_information": [{"code": "S1034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ CAROTID SUBCLAV", "code_information": [{"code": "35695", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAV CAROTID", "code_information": [{"code": "35694", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAVIAN", "code_information": [{"code": "35693", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC 1 SQ CM", "code_information": [{"code": "Q4190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC, 1 MG", "code_information": [{"code": "Q4189", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT CORD PER SQ CM", "code_information": [{"code": "Q4216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT WOUND, PER SQ CM", "code_information": [{"code": "Q4169", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTANE (Trihexyphenidyl HCl) Tab 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003433", "type": "CDM"}, {"code": "70954021210", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTERIAL BLOOD GAS", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "1000079", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 29.98, "maximum": 103.08, "gross_charge": 114.54, "discounted_cash": 54.17, "estimated_discounted_cash": 143.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 91.63, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERIAL STICK", "code_information": [{"code": "36600", "type": "CPT"}, {"code": "1000070", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 40.06, "maximum": 63.26, "gross_charge": 70.29, "discounted_cash": 54.17, "estimated_discounted_cash": 70.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 52.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY EXPOS/GRAFT ARTERY", "code_information": [{"code": "33987", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY TO VEIN SHUNT", "code_information": [{"code": "36835", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY TRANSPOSE/ENDOVAS TAA", "code_information": [{"code": "33889", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAY EACH VESSEL", "code_information": [{"code": "75774", "type": "CPT"}], "standard_charges": [{"minimum": 126.16, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 126.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ABDOMEN", "code_information": [{"code": "75726", "type": "CPT"}], "standard_charges": [{"minimum": 221.28, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 221.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENAL GLAND", "code_information": [{"code": "75731", "type": "CPT"}], "standard_charges": [{"minimum": 192.76, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 192.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENALS", "code_information": [{"code": "75733", "type": "CPT"}], "standard_charges": [{"minimum": 214.41, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 214.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARM/LEG", "code_information": [{"code": "75710", "type": "CPT"}], "standard_charges": [{"minimum": 197.03, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 197.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARMS/LEGS", "code_information": [{"code": "75716", "type": "CPT"}], "standard_charges": [{"minimum": 213.11, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 213.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS CHEST", "code_information": [{"code": "75756", "type": "CPT"}], "standard_charges": [{"minimum": 201.56, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75741", "type": "CPT"}], "standard_charges": [{"minimum": 168.39, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 168.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75746", "type": "CPT"}], "standard_charges": [{"minimum": 171.65, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 171.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNGS", "code_information": [{"code": "75743", "type": "CPT"}], "standard_charges": [{"minimum": 192.25, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 192.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS PELVIS", "code_information": [{"code": "75736", "type": "CPT"}], "standard_charges": [{"minimum": 180.38, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 180.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS SPINE", "code_information": [{"code": "75705", "type": "CPT"}], "standard_charges": [{"minimum": 313.23, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 313.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHR SI JT OPN B1GRF INSTRM", "code_information": [{"code": "27280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 2-3 VRT SGM", "code_information": [{"code": "22808", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 4-7 VRT SGM", "code_information": [{"code": "22810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 8+ VRT SGM", "code_information": [{"code": "22812", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD CERVICAL EA", "code_information": [{"code": "22552", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC CRV", "code_information": [{"code": "22554", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC EA", "code_information": [{"code": "22585", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC LUM", "code_information": [{"code": "22558", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC THC", "code_information": [{"code": "22556", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBDY CERVICAL", "code_information": [{"code": "22551", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT TORAL/XORAL C1-C2", "code_information": [{"code": "22548", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD CMBN 1NTRSPC EA ADDL", "code_information": [{"code": "22634", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD CMBN 1NTRSPC LUMBAR", "code_information": [{"code": "22633", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD GLENOHUMERAL JT W/GRF", "code_information": [{"code": "23802", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD HIP JT SBTRCHC OSTEOT", "code_information": [{"code": "27286", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ EA AD", "code_information": [{"code": "22534", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ LMBR", "code_information": [{"code": "22533", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ THRC", "code_information": [{"code": "22532", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PRE-SAC NTRBDY L5-S1", "code_information": [{"code": "22586", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 13+ VRT SGM", "code_information": [{"code": "22804", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 7-12 VRT SGM", "code_information": [{"code": "22802", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM<6 VRT SGM", "code_information": [{"code": "22800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC CRV", "code_information": [{"code": "22600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC EA ADD", "code_information": [{"code": "22614", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LM EA", "code_information": [{"code": "22632", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LUM", "code_information": [{"code": "22630", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LUMBAR", "code_information": [{"code": "22612", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC THRC", "code_information": [{"code": "22610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ ATLAS-AXIS", "code_information": [{"code": "22595", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ CRANIOCERVICAL", "code_information": [{"code": "22590", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PERQ/MIN NVAS", "code_information": [{"code": "27279", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PRQ WO TFXJ DEV", "code_information": [{"code": "27278", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRO, LOOSE BODY + CHONDRO", "code_information": [{"code": "G0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRO/SHOUL SURG; W/SPACER", "code_information": [{"code": "C9781", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GLENOHUMERAL JT", "code_information": [{"code": "23800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS HIP JOINT", "code_information": [{"code": "27284", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS SYMPHYSIS PUBIS", "code_information": [{"code": "27282", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHROEREISIS, SUBTALAR", "code_information": [{"code": "S2117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHROFLEX", "code_information": [{"code": "Q4125", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDER, SURGI", "code_information": [{"code": "S2300", "type": "HCPCS"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBOW W/SYNOVECTOMY", "code_information": [{"code": "24102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW CAPSL EXC RLS", "code_information": [{"code": "24006", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW EXPL DRG/RMVL FB", "code_information": [{"code": "24000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW JT EXPL BX RMVL", "code_information": [{"code": "24101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW SYNOVIAL BX ONLY", "code_information": [{"code": "24100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58321", "type": "CPT"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58322", "type": "CPT"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL LARYNX, ACCESSORY", "code_information": [{"code": "L8505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL TEARS DROP 1.40%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000015", "type": "CDM"}, {"code": "10119002003", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ARTISS FIBRIN SEALANT", "code_information": [{"code": "C9250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/AORTIC DSJ", "code_information": [{"code": "33858", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/DS OTH/THN DSJ", "code_information": [{"code": "33859", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASA/ANTIPLAT THER USED", "code_information": [{"code": "G8598", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASAY OF INTERLEUKIN-6 (IL-6)", "code_information": [{"code": "83529", "type": "CPT"}], "standard_charges": [{"minimum": 19.86, "maximum": 19.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33863", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33864", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASCENT, 0.5 MG", "code_information": [{"code": "Q4213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASCVD RISK >=20PCT", "code_information": [{"code": "M1364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASHKENAZI JEWISH ASSOC DIS", "code_information": [{"code": "81412", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 2815.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2815.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASO TITER", "code_information": [{"code": "86060", "type": "CPT"}, {"code": "1000108", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.4, "maximum": 38.88, "gross_charge": 43.2, "discounted_cash": 54.17, "estimated_discounted_cash": 43.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 34.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 38.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPA GENE", "code_information": [{"code": "81200", "type": "CPT"}], "standard_charges": [{"minimum": 54.34, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPARAGINASE, NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9020", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AG IA", "code_information": [{"code": "87305", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS ANTIBODY", "code_information": [{"code": "86606", "type": "CPT"}], "standard_charges": [{"minimum": 17.31, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "60300", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/ IMAGING", "code_information": [{"code": "32555", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/O IMAGING", "code_information": [{"code": "32554", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIRATE/INJ GANGLION CYST", "code_information": [{"code": "20612", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIRATION ORBITAL CONTENTS", "code_information": [{"code": "67415", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIRATION/INJECTION MAJOR JOINT", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "11000001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 418.43, "maximum": 767.67, "gross_charge": 734.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 587.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 660.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 418.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRIN (CHEWABLE) TAB 81MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000061", "type": "CDM"}, {"code": "00904750930", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ASPIRIN EC 325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200090", "type": "CDM"}, {"code": "00536123201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ASPIRIN EC 81MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000727", "type": "CDM"}, {"code": "49483048112", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ASPIRIN NOT USED, NO RSN", "code_information": [{"code": "M1057", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIRIN RECVD W/IN 24 HRS", "code_information": [{"code": "4084F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIRIN SUPP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000045", "type": "CDM"}, {"code": "00574703412", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ASPIRIN SUPP 600MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000046", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ASPIRIN TAB 325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000062", "type": "CDM"}, {"code": "00536105429", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ASPIRIN USED", "code_information": [{"code": "M1055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPIRIN/CLOPIDOGREL RXD", "code_information": [{"code": "4086F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY ACID PHOSPHATASE", "code_information": [{"code": "84060", "type": "CPT"}], "standard_charges": [{"minimum": 8.79, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY ACTIVATED PROTEIN C", "code_information": [{"code": "85307", "type": "CPT"}], "standard_charges": [{"minimum": 17.62, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY ALKALINE PHOSPHATASE", "code_information": [{"code": "84078", "type": "CPT"}], "standard_charges": [{"minimum": 9.5, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY AMINOLEVULINIC ACID", "code_information": [{"code": "82135", "type": "CPT"}], "standard_charges": [{"minimum": 18.92, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY ANTI-MULLERIAN HORM", "code_information": [{"code": "82166", "type": "CPT"}], "standard_charges": [{"minimum": 44.41, "maximum": 44.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY BLOOD CATECHOLAMINES", "code_information": [{"code": "82383", "type": "CPT"}], "standard_charges": [{"minimum": 33.44, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY C-D TRANSFER MEASURE", "code_information": [{"code": "82373", "type": "CPT"}], "standard_charges": [{"minimum": 20.77, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY CARBAMAZEPINE FREE", "code_information": [{"code": "80157", "type": "CPT"}], "standard_charges": [{"minimum": 15.24, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY CARBOXYHB QUAL", "code_information": [{"code": "82376", "type": "CPT"}], "standard_charges": [{"minimum": 16.18, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY CHONDROITIN SULFATE", "code_information": [{"code": "82485", "type": "CPT"}], "standard_charges": [{"minimum": 23.75, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY DIR MEAS FR ESTRADIOL", "code_information": [{"code": "82681", "type": "CPT"}], "standard_charges": [{"minimum": 32.13, "maximum": 32.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY DUODENAL FLUID TRYPSIN", "code_information": [{"code": "84485", "type": "CPT"}], "standard_charges": [{"minimum": 8.28, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY FOR PHENCYCLIDINE", "code_information": [{"code": "83992", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY FREE HYDROXYPROLINE", "code_information": [{"code": "83500", "type": "CPT"}], "standard_charges": [{"minimum": 26.05, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY GALACTOSE TRANSFERASE", "code_information": [{"code": "82775", "type": "CPT"}], "standard_charges": [{"minimum": 24.23, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY LIPOPROTEIN PLA2", "code_information": [{"code": "83698", "type": "CPT"}], "standard_charges": [{"minimum": 53.26, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY MALATE DEHYDROGENASE", "code_information": [{"code": "83775", "type": "CPT"}], "standard_charges": [{"minimum": 8.48, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY MYELOPEROXIDASE", "code_information": [{"code": "83876", "type": "CPT"}], "standard_charges": [{"minimum": 58.49, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY NONENDOCRINE RECEPTOR", "code_information": [{"code": "84238", "type": "CPT"}], "standard_charges": [{"minimum": 42.06, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF 17-HYDROXYPREGNENO", "code_information": [{"code": "84143", "type": "CPT"}], "standard_charges": [{"minimum": 26.23, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ADP & AMP", "code_information": [{"code": "82030", "type": "CPT"}], "standard_charges": [{"minimum": 29.67, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ALUMINUM", "code_information": [{"code": "82108", "type": "CPT"}], "standard_charges": [{"minimum": 29.3, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF AMIKACIN", "code_information": [{"code": "80150", "type": "CPT"}], "standard_charges": [{"minimum": 17.34, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ANDROSTERONE", "code_information": [{"code": "82160", "type": "CPT"}], "standard_charges": [{"minimum": 29.38, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ANGIOTENSIN II", "code_information": [{"code": "82163", "type": "CPT"}], "standard_charges": [{"minimum": 23.6, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF B HEXOSAMINIDASE EA", "code_information": [{"code": "83080", "type": "CPT"}], "standard_charges": [{"minimum": 19.4, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BETA-2 PROTEIN", "code_information": [{"code": "82232", "type": "CPT"}], "standard_charges": [{"minimum": 18.61, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BIOTINIDASE", "code_information": [{"code": "82261", "type": "CPT"}], "standard_charges": [{"minimum": 19.4, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD FATTY ACIDS", "code_information": [{"code": "82725", "type": "CPT"}], "standard_charges": [{"minimum": 21.59, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD LIPOPROTEIN", "code_information": [{"code": "83719", "type": "CPT"}], "standard_charges": [{"minimum": 14.66, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD PKU", "code_information": [{"code": "84030", "type": "CPT"}], "standard_charges": [{"minimum": 6.33, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BRADYKININ", "code_information": [{"code": "82286", "type": "CPT"}], "standard_charges": [{"minimum": 5.93, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BREATH ETHANOL", "code_information": [{"code": "82075", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CADMIUM", "code_information": [{"code": "82300", "type": "CPT"}], "standard_charges": [{"minimum": 27.19, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CAROTENE", "code_information": [{"code": "82380", "type": "CPT"}], "standard_charges": [{"minimum": 10.6, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CATHEPSIN-D", "code_information": [{"code": "82387", "type": "CPT"}], "standard_charges": [{"minimum": 20.77, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CHLORAMPHENICOL", "code_information": [{"code": "82415", "type": "CPT"}], "standard_charges": [{"minimum": 14.57, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CORTICOSTERONE", "code_information": [{"code": "82528", "type": "CPT"}], "standard_charges": [{"minimum": 25.9, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CRYOFIBRINOGEN", "code_information": [{"code": "82585", "type": "CPT"}], "standard_charges": [{"minimum": 16.26, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CSF PROTEIN", "code_information": [{"code": "83873", "type": "CPT"}], "standard_charges": [{"minimum": 19.78, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CYANIDE", "code_information": [{"code": "82600", "type": "CPT"}], "standard_charges": [{"minimum": 22.31, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF DIBUCAINE NUMBER", "code_information": [{"code": "82638", "type": "CPT"}], "standard_charges": [{"minimum": 14.09, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF DIGOXIN FREE", "code_information": [{"code": "80163", "type": "CPT"}], "standard_charges": [{"minimum": 15.27, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ENDOCRINE HORMONE", "code_information": [{"code": "84235", "type": "CPT"}], "standard_charges": [{"minimum": 81.91, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 81.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTROGEN", "code_information": [{"code": "84233", "type": "CPT"}], "standard_charges": [{"minimum": 101.06, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTROGENS", "code_information": [{"code": "82671", "type": "CPT"}], "standard_charges": [{"minimum": 37.15, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETHOSUXIMIDE", "code_information": [{"code": "80168", "type": "CPT"}], "standard_charges": [{"minimum": 18.79, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETHYLENE GLYCOL", "code_information": [{"code": "82693", "type": "CPT"}], "standard_charges": [{"minimum": 17.14, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETIOCHOLANOLONE", "code_information": [{"code": "82696", "type": "CPT"}], "standard_charges": [{"minimum": 30.18, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECAL FAT", "code_information": [{"code": "82715", "type": "CPT"}], "standard_charges": [{"minimum": 26.42, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES FOR TRYPSIN", "code_information": [{"code": "84490", "type": "CPT"}], "standard_charges": [{"minimum": 11.42, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES PORPHYRINS", "code_information": [{"code": "84126", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 44.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES/UROBILINOGEN", "code_information": [{"code": "84577", "type": "CPT"}], "standard_charges": [{"minimum": 19.32, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FETAL FIBRONECTIN", "code_information": [{"code": "82731", "type": "CPT"}], "standard_charges": [{"minimum": 74.07, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FLUORIDE", "code_information": [{"code": "82735", "type": "CPT"}], "standard_charges": [{"minimum": 21.32, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FOLIC ACID RBC", "code_information": [{"code": "82747", "type": "CPT"}], "standard_charges": [{"minimum": 17.93, "maximum": 20.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GALACTOSE", "code_information": [{"code": "82760", "type": "CPT"}], "standard_charges": [{"minimum": 12.88, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GDH ENZYME", "code_information": [{"code": "82965", "type": "CPT"}], "standard_charges": [{"minimum": 15.12, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUCAGON", "code_information": [{"code": "82943", "type": "CPT"}], "standard_charges": [{"minimum": 16.43, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUCOSIDASE", "code_information": [{"code": "82963", "type": "CPT"}], "standard_charges": [{"minimum": 24.7, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUTATHIONE", "code_information": [{"code": "82978", "type": "CPT"}], "standard_charges": [{"minimum": 17.77, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLYCATED PROTEIN", "code_information": [{"code": "82985", "type": "CPT"}], "standard_charges": [{"minimum": 19.27, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HALOPERIDOL", "code_information": [{"code": "80173", "type": "CPT"}], "standard_charges": [{"minimum": 18.15, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HAPTOGLOBINS", "code_information": [{"code": "83012", "type": "CPT"}], "standard_charges": [{"minimum": 30.92, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HEMOSIDERIN QUAL", "code_information": [{"code": "83070", "type": "CPT"}], "standard_charges": [{"minimum": 5.46, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HOMOVANILLIC ACID", "code_information": [{"code": "83150", "type": "CPT"}], "standard_charges": [{"minimum": 25.77, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF IDH ENZYME", "code_information": [{"code": "83570", "type": "CPT"}], "standard_charges": [{"minimum": 10.18, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF INSULIN", "code_information": [{"code": "83527", "type": "CPT"}], "standard_charges": [{"minimum": 14.89, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF INTRINSIC FACTOR", "code_information": [{"code": "83528", "type": "CPT"}], "standard_charges": [{"minimum": 22.79, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LAP ENZYME", "code_information": [{"code": "83670", "type": "CPT"}], "standard_charges": [{"minimum": 11.28, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LIDOCAINE", "code_information": [{"code": "80176", "type": "CPT"}], "standard_charges": [{"minimum": 16.89, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LRH HORMONE", "code_information": [{"code": "83727", "type": "CPT"}], "standard_charges": [{"minimum": 19.77, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF MANGANESE", "code_information": [{"code": "83785", "type": "CPT"}], "standard_charges": [{"minimum": 30.65, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF METHEMALBUMIN", "code_information": [{"code": "83857", "type": "CPT"}], "standard_charges": [{"minimum": 12.35, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NEONATAL THYROXINE", "code_information": [{"code": "84437", "type": "CPT"}], "standard_charges": [{"minimum": 7.44, "maximum": 40.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NICKEL", "code_information": [{"code": "83885", "type": "CPT"}], "standard_charges": [{"minimum": 28.19, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NOS VITAMIN", "code_information": [{"code": "84591", "type": "CPT"}], "standard_charges": [{"minimum": 19.62, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NUCLEOTIDASE", "code_information": [{"code": "83915", "type": "CPT"}], "standard_charges": [{"minimum": 12.82, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF OSTEOCALCIN", "code_information": [{"code": "83937", "type": "CPT"}], "standard_charges": [{"minimum": 34.33, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PHENYLKETONES", "code_information": [{"code": "84035", "type": "CPT"}], "standard_charges": [{"minimum": 4.58, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PORPHOBILINOGEN", "code_information": [{"code": "84110", "type": "CPT"}], "standard_charges": [{"minimum": 9.71, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNANEDIOL", "code_information": [{"code": "84135", "type": "CPT"}], "standard_charges": [{"minimum": 24.46, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNANETRIOL", "code_information": [{"code": "84138", "type": "CPT"}], "standard_charges": [{"minimum": 24.21, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PRIMIDONE", "code_information": [{"code": "80188", "type": "CPT"}], "standard_charges": [{"minimum": 19.08, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROCAINAMIDE", "code_information": [{"code": "80190", "type": "CPT"}], "standard_charges": [{"minimum": 33.57, "maximum": 69.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 69.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROGESTERONE", "code_information": [{"code": "84234", "type": "CPT"}], "standard_charges": [{"minimum": 74.61, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROSTAGLANDIN", "code_information": [{"code": "84150", "type": "CPT"}], "standard_charges": [{"minimum": 48.04, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROTEIN ANY SOURCE", "code_information": [{"code": "84160", "type": "CPT"}], "standard_charges": [{"minimum": 6.45, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PSA FREE", "code_information": [{"code": "84154", "type": "CPT"}], "standard_charges": [{"minimum": 21.15, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PYRUVATE", "code_information": [{"code": "84210", "type": "CPT"}], "standard_charges": [{"minimum": 16.65, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PYRUVATE KINASE", "code_information": [{"code": "84220", "type": "CPT"}], "standard_charges": [{"minimum": 10.86, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF QUINIDINE", "code_information": [{"code": "80194", "type": "CPT"}], "standard_charges": [{"minimum": 16.79, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF QUININE", "code_information": [{"code": "84228", "type": "CPT"}], "standard_charges": [{"minimum": 13.37, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF RBC GALACTOKINASE", "code_information": [{"code": "82759", "type": "CPT"}], "standard_charges": [{"minimum": 24.7, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF RBC PG6D ENZYME", "code_information": [{"code": "84085", "type": "CPT"}], "standard_charges": [{"minimum": 10.86, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SELENIUM", "code_information": [{"code": "84255", "type": "CPT"}], "standard_charges": [{"minimum": 29.36, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SEMEN FRUCTOSE", "code_information": [{"code": "82757", "type": "CPT"}], "standard_charges": [{"minimum": 19.94, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SIALIC ACID", "code_information": [{"code": "84275", "type": "CPT"}], "standard_charges": [{"minimum": 15.46, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SILICA", "code_information": [{"code": "84285", "type": "CPT"}], "standard_charges": [{"minimum": 28.99, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SIROLIMUS", "code_information": [{"code": "80195", "type": "CPT"}], "standard_charges": [{"minimum": 15.79, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SOMATOSTATIN", "code_information": [{"code": "84307", "type": "CPT"}], "standard_charges": [{"minimum": 21.02, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SWEAT SODIUM", "code_information": [{"code": "84302", "type": "CPT"}], "standard_charges": [{"minimum": 5.59, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THIOCYANATE", "code_information": [{"code": "84430", "type": "CPT"}], "standard_charges": [{"minimum": 13.37, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THYROGLOBULIN", "code_information": [{"code": "84432", "type": "CPT"}], "standard_charges": [{"minimum": 18.47, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THYROID ACTIVITY", "code_information": [{"code": "84442", "type": "CPT"}], "standard_charges": [{"minimum": 17.0, "maximum": 40.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TRANSCORTIN", "code_information": [{"code": "84449", "type": "CPT"}], "standard_charges": [{"minimum": 20.7, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TROPONIN QUAL", "code_information": [{"code": "84512", "type": "CPT"}], "standard_charges": [{"minimum": 11.6, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TYROSINE", "code_information": [{"code": "84510", "type": "CPT"}], "standard_charges": [{"minimum": 12.22, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE SULFATE", "code_information": [{"code": "84392", "type": "CPT"}], "standard_charges": [{"minimum": 6.31, "maximum": 8.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE UROBILINOGEN", "code_information": [{"code": "84580", "type": "CPT"}], "standard_charges": [{"minimum": 10.98, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VASOPRESSIN", "code_information": [{"code": "84588", "type": "CPT"}], "standard_charges": [{"minimum": 39.03, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VIP", "code_information": [{"code": "84586", "type": "CPT"}], "standard_charges": [{"minimum": 40.63, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VOLATILES", "code_information": [{"code": "84600", "type": "CPT"}], "standard_charges": [{"minimum": 19.68, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY OTHER FLUID CHLORIDES", "code_information": [{"code": "82438", "type": "CPT"}], "standard_charges": [{"minimum": 5.75, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY PH BODY FLUID NOS", "code_information": [{"code": "83986", "type": "CPT"}], "standard_charges": [{"minimum": 4.12, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY PHOSPHATIDYLGLYCEROL", "code_information": [{"code": "84081", "type": "CPT"}], "standard_charges": [{"minimum": 19.0, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY PHOSPHOHEXOSE ENZYMES", "code_information": [{"code": "84087", "type": "CPT"}], "standard_charges": [{"minimum": 12.34, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY RBC GLUTATHIONE", "code_information": [{"code": "82979", "type": "CPT"}], "standard_charges": [{"minimum": 10.86, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY RBC PROTOPORPHYRIN", "code_information": [{"code": "84202", "type": "CPT"}], "standard_charges": [{"minimum": 16.5, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY SPEC XCP UR&BREATH IA", "code_information": [{"code": "82077", "type": "CPT"}], "standard_charges": [{"minimum": 19.86, "maximum": 19.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY SYNOVIAL FLUID MUCIN", "code_information": [{"code": "83872", "type": "CPT"}], "standard_charges": [{"minimum": 6.74, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY TOTAL HYDROXYPROLINE", "code_information": [{"code": "83505", "type": "CPT"}], "standard_charges": [{"minimum": 27.95, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY TOXIN OR ANTITOXIN", "code_information": [{"code": "87230", "type": "CPT"}], "standard_charges": [{"minimum": 22.7, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSAY URINE CATECHOLAMINES", "code_information": [{"code": "82382", "type": "CPT"}], "standard_charges": [{"minimum": 31.4, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSER COM TX FACE-FACE/15MIN", "code_information": [{"code": "H0039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSERT COMM TX PGM PER DIEM", "code_information": [{"code": "H0040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESS ANGINAL SYMPTOM/LEVEL", "code_information": [{"code": "1002F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESS CYST CONTRAST INJECT", "code_information": [{"code": "49424", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESS DYSPNEA NOT PRESENT", "code_information": [{"code": "1018F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESS DYSPNEA PRESENT", "code_information": [{"code": "1019F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESS OF SALIVARY FLOW", "code_information": [{"code": "D0419", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESS VOL MGMT NOT DOC", "code_information": [{"code": "G8958", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT FOR HEARING AID", "code_information": [{"code": "V5010", "type": "HCPCS"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT OF A PATIENT", "code_information": [{"code": "D0191", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT OF APHASIA", "code_information": [{"code": "96105", "type": "CPT"}], "standard_charges": [{"minimum": 1848.13, "maximum": 1848.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1848.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSIST LIVING WAIVER/DIEM", "code_information": [{"code": "T2031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSIST LIVING WAIVER/MONTH", "code_information": [{"code": "T2030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89280", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 657.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 657.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89281", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 780.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 780.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSISTIVE TECHNOLOGY ASSESS", "code_information": [{"code": "97755", "type": "CPT"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSMT & CARE PLN PT COG IMP", "code_information": [{"code": "99483", "type": "CPT"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASST OOCYTE FERT CASE RATE", "code_information": [{"code": "S4022", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSTV ALG ECG RSK ASMT CNCRT", "code_information": [{"code": "764T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSTV ALG ECG RSK ASMT PREV", "code_information": [{"code": "765T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AST", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "1000198", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 27.54, "gross_charge": 30.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AST CANISTER W/GEL", "code_information": [{"code": "3001117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.32, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ASTH CONTROLLED", "code_information": [{"code": "G9432", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTH NOT CONTROLLED", "code_information": [{"code": "G9434", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTHMA DISCHARGE PLAN PRESNT", "code_information": [{"code": "5250F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTHMA EDUCATION", "code_information": [{"code": "S9441", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTHMA IMPAIRMENT ASSESSED", "code_information": [{"code": "2015F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTHMA KIT", "code_information": [{"code": "S8097", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTHMA RISK ASSESSED", "code_information": [{"code": "2016F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTHMA SYMPTOMS EVALUATE", "code_information": [{"code": "1005F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTIGMATISM-CORRECT FUNCTION", "code_information": [{"code": "V2787", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTRAZENECA VACC ADM 1ST DOS", "code_information": [{"code": "D1705", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTRAZENECA VACC ADM 2ND DOS", "code_information": [{"code": "D1706", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASXL1 FULL GENE SEQUENCE", "code_information": [{"code": "81175", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 777.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 777.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASXL1 GENE TARGET SEQ ALYS", "code_information": [{"code": "81176", "type": "CPT"}], "standard_charges": [{"minimum": 278.19, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 278.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASY CARBAMAZEPIN 10,11-EPXID", "code_information": [{"code": "80161", "type": "CPT"}], "standard_charges": [{"minimum": 21.44, "maximum": 21.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASY HYDROXYCORTICOSTEROIDS17", "code_information": [{"code": "83491", "type": "CPT"}], "standard_charges": [{"minimum": 20.59, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASY THIOPURIN S-MTHYLTRNSFRS", "code_information": [{"code": "84433", "type": "CPT"}], "standard_charges": [{"minimum": 25.94, "maximum": 25.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASYMPT CAROT/VRTBRBAS STEN", "code_information": [{"code": "9005F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATARAX (HYDROXYZINE HCL) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000479", "type": "CDM"}, {"code": "63739048310", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATARAX (HYDROXYZINE HCL) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000261", "type": "CDM"}, {"code": "60687067501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATARAX (HYDROXYZINE) LIQ 10MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000221", "type": "CDM"}, {"code": "54838050280", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 20.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATHEROSCLEROSIS WITH MCC", "code_information": [{"code": "302", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [{"code": "303", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL HIGH CMPLX", "code_information": [{"code": "97171", "type": "CPT"}], "standard_charges": [{"minimum": 48.87, "maximum": 48.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL LOW CMPLX", "code_information": [{"code": "97169", "type": "CPT"}], "standard_charges": [{"minimum": 48.87, "maximum": 48.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN EVAL MOD CMPLX", "code_information": [{"code": "97170", "type": "CPT"}], "standard_charges": [{"minimum": 48.87, "maximum": 48.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATHLETIC TRN RE-EVAL PLAN CR", "code_information": [{"code": "97172", "type": "CPT"}], "standard_charges": [{"minimum": 24.44, "maximum": 24.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATIVAN (LORAZEPAM) 2MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2060", "type": "HCPCS"}, {"code": "7000292", "type": "CDM"}, {"code": "00641600125", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 18.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATIVAN (LORAZEPAM) LIQUID 2MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000511", "type": "CDM"}, {"code": "00054353244", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATIVAN (LORAZEPAM) TAB 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000293", "type": "CDM"}, {"code": "69315090401", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATIVAN (LORAZEPAM) TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000294", "type": "CDM"}, {"code": "69315090501", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATM MRNA SEQ ALYS", "code_information": [{"code": "136U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATN1 GENE DETC ABNOR ALLELES", "code_information": [{"code": "81177", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATOMIC ABSORPTION", "code_information": [{"code": "82190", "type": "CPT"}], "standard_charges": [{"minimum": 18.29, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATROPINE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7635", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATROPINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7636", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATROPINE SULFATE 1% OPTH DROPS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000945", "type": "CDM"}, {"code": "60505622601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATROPINE SULFATE 1MG/10ML INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J0461", "type": "HCPCS"}, {"code": "7000049", "type": "CDM"}, {"code": "76329333901", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROVENT (IPRATROPIUM) INH 0.5MG/2.5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000250", "type": "CDM"}, {"code": "60687039483", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51841", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTACH OCULAR IMPLANT", "code_information": [{"code": "65140", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC AFTER CARE", "code_information": [{"code": "59622", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY", "code_information": [{"code": "59618", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY ONLY", "code_information": [{"code": "59620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTENDANCE AT DELIVERY", "code_information": [{"code": "99464", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTENDANT CARE SERVICE /15M", "code_information": [{"code": "S5125", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTENDANT CARE SERVICE /DIEM", "code_information": [{"code": "S5126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTENDANT CONTROL", "code_information": [{"code": "E2331", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTRA-TAIN CR", "code_information": [{"code": "3001112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ATXN1 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81178", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATXN10 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81183", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATXN2 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81179", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATXN3 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81180", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATXN7 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81181", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATXN8OS GEN DETC ABNOR ALLEL", "code_information": [{"code": "81182", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUD BRAINSTEM IMPLT PROGRAMG", "code_information": [{"code": "92640", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUD REHAB POSTLING HEAR LOSS", "code_information": [{"code": "92633", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUD REHAB PRE-LING HEAR LOSS", "code_information": [{"code": "92630", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIO-ONLY HHS", "code_information": [{"code": "G0321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIOLOGY SS", "code_information": [{"code": "G0062", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "209T", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "92553", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR ONLY", "code_information": [{"code": "208T", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY FOR HEARING AID", "code_information": [{"code": "S0618", "type": "HCPCS"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST 15-30 MIN", "code_information": [{"code": "99408", "type": "CPT"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST OVER 30 MIN", "code_information": [{"code": "99409", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION + 15 MIN", "code_information": [{"code": "92621", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION 60 MIN", "code_information": [{"code": "92620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION CHEEK BONE", "code_information": [{"code": "21270", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21125", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21127", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION OF FACIAL BONES", "code_information": [{"code": "21208", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUGMENTIN (AMOX/POT CLAV) TAB 500/125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000726", "type": "CDM"}, {"code": "42571016142", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AUGMENTIN (NF-Augmentin) Tablet 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002674", "type": "CDM"}, {"code": "00781187431", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AUGMENTIN ES-600MG SUSPENSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004298", "type": "CDM"}, {"code": "65862053513", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AUGMENTIN SUSP 200/28.5/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000804", "type": "CDM"}, {"code": "66685101100", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 8.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AUGMENTIN SUSP 250/62.5/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200048", "type": "CDM"}, {"code": "60432006575", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 90.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AUGMENTIN TAB 875/125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000051", "type": "CDM"}, {"code": "65862050301", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AUGMNT AI-BASED FCL PHNT A/R", "code_information": [{"code": "731T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AURIC/PERI PAIN ASSESSED", "code_information": [{"code": "1116F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AURICULAR ELECTROSTIMULATION", "code_information": [{"code": "S8930", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AURICULAR PROSTHESIS", "code_information": [{"code": "D5914", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AURICULAR REPLACEMENT", "code_information": [{"code": "D5927", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUROTHIOGLUCOSE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2910", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29866", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO ALYS XST CT STD VRT FX", "code_information": [{"code": "691T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO CELL PROCESS SYS", "code_information": [{"code": "C1832", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO INTERM PERITONEAL DIALY", "code_information": [{"code": "E1592", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ CPTR ALYS", "code_information": [{"code": "625T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ DATA PREP", "code_information": [{"code": "624T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ I&R", "code_information": [{"code": "626T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUANTIFICATION C PLAQUE", "code_information": [{"code": "623T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO TISSUE GRAFT 1ST TOOTH", "code_information": [{"code": "D4273", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO TISSUE GRAFT ADDL TOOTH", "code_information": [{"code": "D4283", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOCHONDROCYTE IMPLANT KNEE", "code_information": [{"code": "27412", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOIMMUNE RA ALYS 12 BMRK", "code_information": [{"code": "81490", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 966.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 966.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS HRVG", "code_information": [{"code": "565T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS NJX", "code_information": [{"code": "566T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOLOG PRP NOT DIAB ULCER", "code_information": [{"code": "G0460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BLOOD OP SALVAGE", "code_information": [{"code": "86891", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 144.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 144.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BLOOD PROCESS", "code_information": [{"code": "86890", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 102.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 102.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC", "code_information": [{"code": "16", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC", "code_information": [{"code": "17", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "AUTOMATED DIFF WBC COUNT", "code_information": [{"code": "85004", "type": "CPT"}], "standard_charges": [{"minimum": 7.44, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOMATED PLATELET COUNT", "code_information": [{"code": "85049", "type": "CPT"}], "standard_charges": [{"minimum": 5.15, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOMATED RBC COUNT", "code_information": [{"code": "85041", "type": "CPT"}], "standard_charges": [{"minimum": 3.47, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOMATIC BP MONITOR, DIAL", "code_information": [{"code": "A4670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV ADRENRG INERVJ", "code_information": [{"code": "95922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV PARASYM INERVJ", "code_information": [{"code": "95921", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV SYST FUNJ TEST", "code_information": [{"code": "95923", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88020", "type": "CPT"}], "standard_charges": [{"minimum": 372.48, "maximum": 372.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 372.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88025", "type": "CPT"}], "standard_charges": [{"minimum": 360.47, "maximum": 360.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 360.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88027", "type": "CPT"}], "standard_charges": [{"minimum": 384.5, "maximum": 384.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 384.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88028", "type": "CPT"}], "standard_charges": [{"minimum": 216.28, "maximum": 216.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 216.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88029", "type": "CPT"}], "standard_charges": [{"minimum": 216.28, "maximum": 216.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 216.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88000", "type": "CPT"}], "standard_charges": [{"minimum": 216.28, "maximum": 216.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 216.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88005", "type": "CPT"}], "standard_charges": [{"minimum": 252.33, "maximum": 252.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 252.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88007", "type": "CPT"}], "standard_charges": [{"minimum": 264.34, "maximum": 264.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 264.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88012", "type": "CPT"}], "standard_charges": [{"minimum": 216.28, "maximum": 216.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 216.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88014", "type": "CPT"}], "standard_charges": [{"minimum": 198.26, "maximum": 198.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 198.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88016", "type": "CPT"}], "standard_charges": [{"minimum": 276.36, "maximum": 276.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 276.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOTRANSPLANT PARATHYROID", "code_information": [{"code": "60512", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION", "code_information": [{"code": "36833", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION OPEN", "code_information": [{"code": "36832", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM BASILIC", "code_information": [{"code": "36819", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM CEPHALIC", "code_information": [{"code": "36818", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AV FUSION DIRECT ANY SITE", "code_information": [{"code": "36821", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AV FUSION/FOREARM VEIN", "code_information": [{"code": "36820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AVALIDE (IRBE/HCTZ) 300/25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000298", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AVALIDE (IRBES/HCTZ) 150/12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000052", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AVALIDE (IRBES/HCTZ) 300MG/12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000053", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AVANDIA (ROSIGLITAZONE MALEAT) TAB 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000054", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AVAPRO (IRBESARTAN) TABLET 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001040", "type": "CDM"}, {"code": "62332004190", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AVEENO LOTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000743", "type": "CDM"}, {"code": "08137001579", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 32.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AVELOX (MOXIFLOXACIN HCL) TAB 400MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000775", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AVODART (DUTASTERIDE) CAP 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000404", "type": "CDM"}, {"code": "31722013190", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AVULSION NAIL SIMPLE TECH", "code_information": [{"code": "11730", "type": "CPT"}, {"code": "11000021", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AXICABTAGENE CILOLEUCEL CAR+", "code_information": [{"code": "Q2041", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AXOLOTL AMBIENT, CRYO 0.1 MG", "code_information": [{"code": "Q4215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AZACITIDINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9025", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE PARENTERAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7500", "type": "HCPCS"}, {"code": "72000815", "type": "CDM"}, {"code": "51079062006", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZILECT (RASAGILINE) 1MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002015", "type": "CDM"}, {"code": "67877026030", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.37, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AZITHROMYCIN DIHYDRATE, ORAL", "code_information": [{"code": "Q0144", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AZMACORT (TRIAMCINOLONE) 0.1% TOP15GM*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000468", "type": "CDM"}, {"code": "51672126705", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AZMACORT (TRIAMCINOLONE) INH : 100MCG*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000057", "type": "CDM"}, {"code": "00075006037", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AZULFIDINE (NF-SULFASALAZINE) 500MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001870", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Abiomend Membrane and Abiomend Hydromembrane, per square centimeter", "code_information": [{"code": "Q4356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Abiomend XPlus Membrane and Abiomend XPlus Hydromembrane, per square centimeter", "code_information": [{"code": "Q4355", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ablation of 1 or more thyroid nodule(s), additional lobe, percutaneous, including imaging guidance, radiofrequency (List separately in addition to code for primary procedure)", "code_information": [{"code": "60661", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ablation of 1 or more thyroid nodule(s), one lobe or the isthmus, percutaneous, including imaging guidance, radiofrequency", "code_information": [{"code": "60660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ablation of benign prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance", "code_information": [{"code": "950T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation", "code_information": [{"code": "55881", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, includin", "code_information": [{"code": "55882", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ablation, benign breast tumor (eg, fibroadenoma), percutaneous, laser, including imaging guidance when performed, each tumor", "code_information": [{"code": "970T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ablation, malignant breast tumor(s), percutaneous, laser, including imaging guidance when performed, unilateral", "code_information": [{"code": "971T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including neuronavigation, delivery and management, subsequent motor threshold redetermination with delivery and management, per treatment day", "code_information": [{"code": "892T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including neuronavigation, delivery and management, subsequent treatment day", "code_information": [{"code": "891T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including target assessment, initial motor threshold determination, neuronavigation, delivery and management, initial treatment day", "code_information": [{"code": "890T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Accessory for speech generating device, electromyographic sensor", "code_information": [{"code": "E2513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Acesso AC, per square centimeter", "code_information": [{"code": "Q4312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Acesso, per square centimeter", "code_information": [{"code": "Q4311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Acetylcholine receptor (AChR), antibody identification by immunofluorescence, using live cells, reported as positive or negative", "code_information": [{"code": "545U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Acute PVD", "code_information": [{"code": "M1383", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Adapter, single-use (i.e. disposable), for attaching ultrasound system to upper gastrointestinal endoscope", "code_information": [{"code": "C1606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Add low ext mec limb vol sys", "code_information": [{"code": "L5783", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Addition endoskletl knee-shi", "code_information": [{"code": "L5841", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Addition to upper extremity prosthesis, partial hand including fingers, acrylic material", "code_information": [{"code": "L6033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal)", "code_information": [{"code": "L6032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Addition to upper extremity, user adjustable, mechanical, residual limb volume management system", "code_information": [{"code": "L7406", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Adhesive clip ext ens contr", "code_information": [{"code": "A4438", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ASCVD) risk assessment, 5-15 minutes, not more often than every 12 months", "code_information": [{"code": "G0537", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Adult day center, 8-hour unit, for use in CMMI model", "code_information": [{"code": "G0530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Advair HFA 115/21 Inh Aer 115MCG-21MC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004164", "type": "CDM"}, {"code": "00173071622", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 640.62, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Advanced primary care management services for a patient that is a qualified Medicare beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant ", "code_information": [{"code": "G0558", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompe", "code_information": [{"code": "G0557", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Advanced primary care management services for a patient with one chronic condition [expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functio", "code_information": [{"code": "G0556", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AdvoGraft Dual, per square centimeter", "code_information": [{"code": "Q4382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AdvoGraft One, per square centimeter", "code_information": [{"code": "Q4380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AeroGuard, per square centimeter", "code_information": [{"code": "Q4370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Afamitresgene autoleucel, including leukapheresis and dose preparation procedures, per therapeutic dose", "code_information": [{"code": "Q2057", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Air polymer-type A intrauterine foam, per study dose", "code_information": [{"code": "S4024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "All patients who were diagnosed with recurrent melanoma during the current performance period", "code_information": [{"code": "M1391", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AmchoPlast Excel, per square centimeter", "code_information": [{"code": "Q4372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AmchoPlast, per square centimeter", "code_information": [{"code": "Q4316", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AmchoThick, per square centimeter", "code_information": [{"code": "Q4368", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Amchoplast FD, per square centimeter", "code_information": [{"code": "Q4360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Amer am ac tri-lay per sq cm", "code_information": [{"code": "Q4305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Americ amnion ac per sq cm", "code_information": [{"code": "Q4306", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "American amnion, per sq cm", "code_information": [{"code": "Q4307", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Amnio Burgeon Dual-Layer Membrane, per square centimeter", "code_information": [{"code": "Q4365", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Amnio Burgeon Membrane and Hydromembrane, per square centimeter", "code_information": [{"code": "Q4363", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Amnio Burgeon XPlus membrane and XPlus hydromembrane, per square centimeter", "code_information": [{"code": "Q4364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AmnioCore SL, per square centimeter", "code_information": [{"code": "Q4367", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AmnioDefend FT Matrix, per square centimeter", "code_information": [{"code": "Q4379", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AmnioPlast 3, per square centimeter", "code_information": [{"code": "Q4369", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AmnioTX, per square centimeter", "code_information": [{"code": "Q4324", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Amnioplast 1, per square centimeter", "code_information": [{"code": "Q4334", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Amnioplast 2, per square centimeter", "code_information": [{"code": "Q4335", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "An additional encounter with an RA diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an RA diagnosis during the performance period", "code_information": [{"code": "M1374", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "An additional encounter with an RA diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an RA diagnosis during the performance period", "code_information": [{"code": "M1375", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "An additional encounter with an RA diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an RA diagnosis during the performance period", "code_information": [{"code": "M1376", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf", "code_information": [{"code": "L1933", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf", "code_information": [{"code": "L1952", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Anoscopy with directed submucosal injection of bulking agent into anal canal", "code_information": [{"code": "963T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 480 sq cm or part thereof (", "code_information": [{"code": "15018", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 480 sq cm or less", "code_information": [{"code": "15017", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; each additional 480 sq cm or part thereof (List separately in addition to code for primary procedure)", "code_information": [{"code": "15016", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; first 480 sq cm or less", "code_information": [{"code": "15015", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Aquaphor Healing Ointment", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003569", "type": "CDM"}, {"code": "72140003147", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 69.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ArdeoGraft, per square centimeter", "code_information": [{"code": "Q4333", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Artacent C, per square centimeter", "code_information": [{"code": "Q4336", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Artacent Trident, per square centimeter", "code_information": [{"code": "Q4337", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Artacent Velos, per square centimeter", "code_information": [{"code": "Q4338", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Artacent VeriClen, per square centimeter", "code_information": [{"code": "Q4339", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Arthroplasty, intercarpal or carpometacarpal joints; suspension, including transfer or transplant of tendon, with interposition, when performed", "code_information": [{"code": "25448", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Artificial saliva, 1 ml", "code_information": [{"code": "A9154", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Assistive algorithmic analysis of acoustic and electrocardiogram recording for detection of cardiac dysfunction (eg, reduced ejection fraction, cardiac murmurs, atrial fibrillation), with review and interpretation by a physician or other qualified health ", "code_information": [{"code": "962T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Assistive algorithmic classification of burn healing (ie, healing or nonhealing) by noninvasive multispectral imaging, including system set-up and acquisition, selection, and transmission of images, with automated generation of report", "code_information": [{"code": "972T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Atherosclerotic cardiovascular disease (ASCVD) risk management services; clinical staff time; per calendar month", "code_information": [{"code": "G0538", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Augmentative analysis of chest computed tomography (CT) imaging data to provide categorical diagnostic subtype classification of interstitial lung disease; obtained with concurrent CT examination of the same structure", "code_information": [{"code": "878T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Augmentative analysis of chest computed tomography (CT) imaging data to provide categorical diagnostic subtype classification of interstitial lung disease; obtained without concurrent CT examination of any structure contained in previously acquired diagno", "code_information": [{"code": "877T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Augmentative analysis of chest computed tomography (CT) imaging data to provide categorical diagnostic subtype classification of interstitial lung disease; physician or other qualified health care professional interpretation and report", "code_information": [{"code": "880T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Augmentative analysis of chest computed tomography (CT) imaging data to provide categorical diagnostic subtype classification of interstitial lung disease; radiological data preparation and transmission", "code_information": [{"code": "879T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Autoimmune diseases (systemic lupus erythematosus [SLE]), analysis of 10 cytokine soluble mediator biomarkers by immunoassay, plasma, individual components reported with an algorithmic risk score for current disease activity", "code_information": [{"code": "446U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Autoimmune diseases (systemic lupus erythematosus [SLE]), analysis of 11 cytokine soluble mediator biomarkers by immunoassay, plasma, individual components reported with an algorithmic prognostic risk score for developing a clinical flare", "code_information": [{"code": "447U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Autoinflammatory disease (VEXAS syndrome), DNA, UBA1 gene mutations, targeted variant analysis (M41T, M41V, M41L, c.118-2A>C, c.118-1G>C, c.118-9_118-2del, S56F, S621C)", "code_information": [{"code": "500U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Axolotl DualGraft, per square centimeter", "code_information": [{"code": "Q4332", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Axolotl Graft, per square centimeter", "code_information": [{"code": "Q4331", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Azopt Ophth Suspension 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002909", "type": "CDM"}, {"code": "24208046410", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 451.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "B BRGDRFERI ANTB 12 PRTN IGG", "code_information": [{"code": "42U", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B BRGDRFERI ANTB 5 PRTN IGM", "code_information": [{"code": "41U", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B BRGDRFERI LYME DS OSPA EVL", "code_information": [{"code": "316U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B CELLS TOTAL COUNT", "code_information": [{"code": "86355", "type": "CPT"}], "standard_charges": [{"minimum": 43.39, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B PERTUSSIS B PARAPERTUSSIS PCR", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "1000726", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 40.35, "maximum": 186.97, "gross_charge": 207.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 166.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 186.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 118.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B PERTUSSIS IgG QUANT", "code_information": [{"code": "86615", "type": "CPT"}, {"code": "1000566", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "gross_charge": 100.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B PERTUSSIS IgM QUANT", "code_information": [{"code": "86615", "type": "CPT"}, {"code": "1000565", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "gross_charge": 100.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B-12 BINDING CAPACITY", "code_information": [{"code": "82608", "type": "CPT"}], "standard_charges": [{"minimum": 16.47, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B/P CUFF CHILD", "code_information": [{"code": "80001084", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "B/P CUFF CRITION 2466", "code_information": [{"code": "80001077", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "B/P CUFF LG/ADULT FOR MACHINE 470430", "code_information": [{"code": "80001083", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "B/P CUFF RED COLIN", "code_information": [{"code": "80001081", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "B1 MATRL QUAL TST MCRIND TIB", "code_information": [{"code": "547T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK ANALYSIS", "code_information": [{"code": "554T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK ASSESSMENT", "code_information": [{"code": "556T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK I&R", "code_information": [{"code": "557T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK VRT FX ASSMT", "code_information": [{"code": "743T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK ASMT DXRBMD1VW", "code_information": [{"code": "750T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK ASSMT DXR-BMD", "code_information": [{"code": "749T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK TRANSMIS DATA", "code_information": [{"code": "555T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B12 & FOLATE", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "1099022", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.91, "maximum": 78.32, "gross_charge": 87.03, "discounted_cash": 54.17, "estimated_discounted_cash": 87.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BABESIA MICROTI AMP PRB", "code_information": [{"code": "87469", "type": "CPT"}], "standard_charges": [{"minimum": 41.06, "maximum": 41.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BACITRACIN OINT 500U/GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000059", "type": "CDM"}, {"code": "00713028031", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [{"code": "519", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [{"code": "518", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "520", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BACK SCHOOL VISIT", "code_information": [{"code": "S9117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BACLOFEN 10 MG INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0475", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BACLOFEN INTRATHECAL TRIAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BACLOFEN TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000060", "type": "CDM"}, {"code": "58657093105", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BACLOFEN TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000998", "type": "CDM"}, {"code": "63739048010", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "95", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "94", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "96", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BACTERICIDAL LEVEL SERUM", "code_information": [{"code": "87197", "type": "CPT"}], "standard_charges": [{"minimum": 17.27, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BACTERIUM ANTIBODY", "code_information": [{"code": "86609", "type": "CPT"}], "standard_charges": [{"minimum": 14.81, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BACTRIM DS TAB 800/160MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000440", "type": "CDM"}, {"code": "00904272561", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BACTRIM PED SUSP 200MG/40MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000441", "type": "CDM"}, {"code": "00121085416", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BACTROBAN (MUPIROCIN) 2% OINT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000093", "type": "CDM"}, {"code": "51672131200", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BAG FEEDING 1500CC", "code_information": [{"code": "3000077", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BAG ICE 50/CS AHS 11", "code_information": [{"code": "3000079", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BAG URINARY METER", "code_information": [{"code": "3000411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BALLISTOCARDIOGRAM", "code_information": [{"code": "S3902", "type": "HCPCS"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BALLOON DILATE URTRL STRIX", "code_information": [{"code": "50706", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BALO ANGIOP CTR DIALYSIS SEG", "code_information": [{"code": "36907", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BANANA BERRY SMOTHIE 450", "code_information": [{"code": "80000183", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BAND STABILIZATION PER TOOTH", "code_information": [{"code": "D2976", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BANDAGE PLASTER FS 2", "code_information": [{"code": "3000080", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BANDAGE PLASTER FS 3", "code_information": [{"code": "3000081", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BANDAGE PLASTER FS 4", "code_information": [{"code": "3000082", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BANDAGE PLASTER FS 6", "code_information": [{"code": "3000083", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BANDAID 1 STRIPS", "code_information": [{"code": "3000413", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BANDAID EX LG", "code_information": [{"code": "3000414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BARBITUATES SERUM", "code_information": [{"code": "80345", "type": "CPT"}, {"code": "1000823", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 60.3, "gross_charge": 67.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 53.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 60.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARIATRIC BED PAN", "code_information": [{"code": "3001447", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 30.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BARIUM SWALLOW TEST NOT REQ", "code_information": [{"code": "3200F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BARIUM SWALLOW TEST ORDERED", "code_information": [{"code": "3142F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BARRERA SLOR DL PER SQ CM", "code_information": [{"code": "Q4281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA AMP PROBE", "code_information": [{"code": "87471", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA QUANT", "code_information": [{"code": "87472", "type": "CPT"}], "standard_charges": [{"minimum": 49.27, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BASELIN FLO CYTOMETRY B/4 TX", "code_information": [{"code": "3170F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BASELINE MRS > 2", "code_information": [{"code": "M1236", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BASIC CHANNEL KIT/NEG WOUND", "code_information": [{"code": "3001118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BASIC LIFE DISABILITY EXAM", "code_information": [{"code": "99450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BASIC LIFE SUPPORT MILEAGE", "code_information": [{"code": "A0380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BASIC METABOLIC PANEL", "code_information": [{"code": "80048", "type": "CPT"}, {"code": "1000152", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.73, "maximum": 45.09, "gross_charge": 50.1, "discounted_cash": 54.17, "estimated_discounted_cash": 50.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASIC SUPPORT ROUTINE SUPPLS", "code_information": [{"code": "A0382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BASIC VESTIBULAR EVALUATION", "code_information": [{"code": "92540", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BASILIXIMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0480", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATH CONDUCTIVITY METER", "code_information": [{"code": "E1550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATH TUB RAIL FLOOR", "code_information": [{"code": "E0242", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATH TUB WALL RAIL", "code_information": [{"code": "E0241", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATH/SHOWER CHAIR", "code_information": [{"code": "E0240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATT PACK/CART, PORT CONC", "code_information": [{"code": "E1356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATTERY CABLES", "code_information": [{"code": "A4612", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATTERY CHARGER", "code_information": [{"code": "A4613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATTERY CHARGER, PORT CONC", "code_information": [{"code": "E1357", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BATTERY FOR HEARING DEVICE", "code_information": [{"code": "V5266", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BB ABO TYPE", "code_information": [{"code": "86900", "type": "CPT"}, {"code": "1400009", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.44, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "estimated_discounted_cash": 315.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB ADMINISTRATION OF BLOOD COMPONENT", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "1400003", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 641.36, "maximum": 1469.15, "gross_charge": 1125.21, "discounted_cash": 54.17, "estimated_discounted_cash": 1211.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 843.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 900.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1012.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 641.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB AHG PHASE OF CROSSMATCH", "code_information": [{"code": "86922", "type": "CPT"}, {"code": "1400011", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 38.52, "maximum": 348.78, "gross_charge": 387.54, "discounted_cash": 54.17, "estimated_discounted_cash": 387.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 310.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 348.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 220.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB ANTIBODY ID RBC ANTIBODIES", "code_information": [{"code": "86870", "type": "CPT"}, {"code": "1400008", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 33.38, "maximum": 581.66, "gross_charge": 646.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 517.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 581.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 368.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB ANTIBODY SCREEN", "code_information": [{"code": "86850", "type": "CPT"}, {"code": "1000271", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.24, "maximum": 36.8, "gross_charge": 40.89, "discounted_cash": 54.17, "estimated_discounted_cash": 40.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.71, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB ANTIGEN SCREENING", "code_information": [{"code": "86902", "type": "CPT"}, {"code": "1000273", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.3, "maximum": 581.4, "gross_charge": 646.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 516.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 581.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 368.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB ANTIGEN TYPING", "code_information": [{"code": "86902", "type": "CPT"}, {"code": "1000519", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.3, "maximum": 581.4, "gross_charge": 646.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 516.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 581.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 368.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB BLOOD GROUP &RH (D)", "code_information": [{"code": "86901", "type": "CPT"}, {"code": "1000272", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.44, "maximum": 31.5, "gross_charge": 35.0, "discounted_cash": 54.17, "estimated_discounted_cash": 35.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB BLOOD TRANSFUSION", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "1099026", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 445.35, "maximum": 1469.15, "gross_charge": 781.32, "discounted_cash": 54.17, "estimated_discounted_cash": 1211.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 585.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 625.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 703.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 445.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB CROSSMATCH UNIT", "code_information": [{"code": "86922", "type": "CPT"}, {"code": "1000274", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 38.52, "maximum": 348.78, "gross_charge": 387.54, "discounted_cash": 54.17, "estimated_discounted_cash": 387.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 310.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 348.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 220.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB DIRECT COOMBS", "code_information": [{"code": "86880", "type": "CPT"}, {"code": "1000466", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.2, "maximum": 86.22, "gross_charge": 95.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 76.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 86.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB FRESH FROZEN PLASMA", "code_information": [{"code": "P9059", "type": "HCPCS"}, {"code": "1099028", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 108.3, "maximum": 1469.15, "gross_charge": 190.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 152.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 171.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 108.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB HEMOLYSIS/AGGLUTININS INC PREWARM", "code_information": [{"code": "86941", "type": "CPT"}, {"code": "1400012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.93, "maximum": 96.7, "gross_charge": 71.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.33, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB HIGH INDIDENCE NEG PER UNIT SUBCHG", "code_information": [{"code": "1400007", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 430.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BB INCBUATION OF CROSSMATCH", "code_information": [{"code": "86921", "type": "CPT"}, {"code": "1400010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.73, "maximum": 348.78, "gross_charge": 387.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 310.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 348.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 220.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB INDIRECT COOMBS", "code_information": [{"code": "86885", "type": "CPT"}, {"code": "1000222", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.58, "maximum": 33.38, "gross_charge": 31.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 28.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB IRRADIATED PHERESIS PLATEL EA UNIT", "code_information": [{"code": "P9036", "type": "HCPCS"}, {"code": "1400014", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 948.1, "maximum": 1497.01, "gross_charge": 1663.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1247.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1330.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1497.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 948.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB PEG ANTIBODY ID", "code_information": [{"code": "86870", "type": "CPT"}, {"code": "1000518", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 33.38, "maximum": 581.66, "gross_charge": 646.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 517.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 581.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 368.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB PLATELET PHERESIS", "code_information": [{"code": "P9019", "type": "HCPCS"}, {"code": "1099027", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 156.65, "maximum": 1469.15, "gross_charge": 274.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 206.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 219.86, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 247.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 156.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB PLATELETS EACH UNIT", "code_information": [{"code": "P9019", "type": "HCPCS"}, {"code": "1400002", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 196.56, "maximum": 1469.15, "gross_charge": 344.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 258.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 275.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 310.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 196.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB PRBC IRRADIATED UNIT", "code_information": [{"code": "P9016", "type": "HCPCS"}, {"code": "1400015", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 330.44, "maximum": 1469.15, "gross_charge": 579.72, "discounted_cash": 54.17, "estimated_discounted_cash": 671.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 434.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 463.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 521.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 330.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB PRBC LEUKOCYTE REDUCED PER UNIT", "code_information": [{"code": "P9016", "type": "HCPCS"}, {"code": "1400001", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 330.44, "maximum": 1469.15, "gross_charge": 579.72, "discounted_cash": 54.17, "estimated_discounted_cash": 671.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 434.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 463.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 521.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 330.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCAT1&IKZF1 PRMTR MTHYLN ALY", "code_information": [{"code": "229U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BCG LIVE INTRAVESICAL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BCG VACCINE INTRAVESICAL", "code_information": [{"code": "90586", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BCG VACCINE PERCUT", "code_information": [{"code": "90585", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BCKDHB GENE", "code_information": [{"code": "81205", "type": "CPT"}], "standard_charges": [{"minimum": 109.24, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MAJOR BP", "code_information": [{"code": "81206", "type": "CPT"}], "standard_charges": [{"minimum": 188.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 188.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MAJOR BP QUAN", "code_information": [{"code": "40U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MINOR BP", "code_information": [{"code": "81207", "type": "CPT"}], "standard_charges": [{"minimum": 166.57, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 166.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE OTHER BP", "code_information": [{"code": "81208", "type": "CPT"}], "standard_charges": [{"minimum": 246.81, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 246.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BDY SRF MPG PM/CVDFB TM IMPL", "code_information": [{"code": "695T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BDY SURF MAPG PM/CVDFB F/UP", "code_information": [{"code": "696T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BECAPLERMIN GEL 1%, 0.5 GM", "code_information": [{"code": "S0157", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BECLOMETHASONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BED ACCESSORY BRD/TBL/SUPPRT", "code_information": [{"code": "E0315", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BED BOARD", "code_information": [{"code": "E0273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BED CRADLE (ONE TIME)", "code_information": [{"code": "3000005", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BED PAN DISP", "code_information": [{"code": "3000006", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BED PAN FRACTURE DISP", "code_information": [{"code": "3000007", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BEHAV CHNG SMOKING 3-10 MIN", "code_information": [{"code": "99406", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEHAV CHNG SMOKING > 10 MIN", "code_information": [{"code": "99407", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEHAV HLTH DAY TREAT, PER HR", "code_information": [{"code": "H2012", "type": "HCPCS"}], "standard_charges": [{"minimum": 1671.13, "maximum": 1671.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1671.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEHAVIOR COUNSEL OBESITY 15M", "code_information": [{"code": "G0447", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEHAVIOR MANAGEMENT", "code_information": [{"code": "D9920", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [{"code": "886", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BEHAVRAL QUALIT ANALYS VOICE", "code_information": [{"code": "92524", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "estimated_discounted_cash": 272.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEHIND EAR BINAUR HEARING AI", "code_information": [{"code": "V5140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEHIND EAR HEARING AID", "code_information": [{"code": "V5060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BELATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0485", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BELIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0490", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BELLACELL HD, SUREDERM SQ CM", "code_information": [{"code": "Q4220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BELOW KNEE SURGICAL STOCKING", "code_information": [{"code": "A4500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BELT STRAP SLEEV GRMNT COVER", "code_information": [{"code": "A4467", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BENADRYL (DIPHENHYD) LIQ 12.5MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000209", "type": "CDM"}, {"code": "00904698520", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BENADRYL (DIPHENHYDRAMINE) 50MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1200", "type": "HCPCS"}, {"code": "72000656", "type": "CDM"}, {"code": "00641628225", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 18.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENADRYL (DIPHENHYDRAMINE) CAP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000161", "type": "CDM"}, {"code": "68094001861", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BENEF REFUSES SERVICE, MOD", "code_information": [{"code": "G2022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BENESCH BOOT PAIR CHILD", "code_information": [{"code": "L3213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BENESCH BOOT PAIR INFANT", "code_information": [{"code": "L3212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BENESCH BOOT PAIR JUNIOR", "code_information": [{"code": "L3214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BENICAR (OLMESARTAN MED) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000201", "type": "CDM"}, {"code": "13668024990", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BENICAR (OLMESARTAN MED) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000322", "type": "CDM"}, {"code": "68462043890", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BENICAR HCTZ 20/12.5", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000425", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BENICAR HCTZ TAB 40MG/12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000638", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BENICAR HCTZ TAB 40MG/25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000478", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [{"code": "725", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [{"code": "726", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BENTYL (DICYCLOMINE) 20MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0500", "type": "HCPCS"}, {"code": "7000064", "type": "CDM"}, {"code": "00517198005", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 62.7, "maximum": 99.0, "gross_charge": 110.0, "discounted_cash": 54.17, "estimated_discounted_cash": 110.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 82.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENTYL (DICYCLOMINE) CAP 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000151", "type": "CDM"}, {"code": "60687036901", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BENZODIAZEPINE BLOOD", "code_information": [{"code": "80346", "type": "CPT"}, {"code": "1000822", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "gross_charge": 109.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.57, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENZODIAZEPINES 13 OR MORE", "code_information": [{"code": "80347", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BENZOIN TINCTURE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001152", "type": "CDM"}, {"code": "71814041001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.18, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BEST PCT PT SAFETY EM MVP", "code_information": [{"code": "G0057", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETA BLCKR ADMIN W/IN 24 HRS", "code_information": [{"code": "4115F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETA NOT GIVEN NO REASON", "code_information": [{"code": "G9188", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETA PRES OR ALREADY TAKING", "code_information": [{"code": "G9189", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETA-BLOC RX PT W/ABN LVEF", "code_information": [{"code": "G8450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETA-BLOCKER THERAPY RXD/TKN", "code_information": [{"code": "4008F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETA-HYDROXYBUTYRIC ACID", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "1000932", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.4, "maximum": 43.52, "gross_charge": 48.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 38.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 43.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETA2-GLYCOPROTEIN AbIgA/IgG/IgM", "code_information": [{"code": "86146", "type": "CPT"}, {"code": "1000838", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 29.27, "maximum": 133.2, "gross_charge": 148.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 118.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 133.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 84.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETADINE SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3000086", "type": "CDM"}, {"code": "67618015004", "type": "NDC"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BETADINE/IODINE SWABS/WIPES", "code_information": [{"code": "A4247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETADINE/PHISOHEX SOLUTION", "code_information": [{"code": "A4246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETAMETHASONE ACET&SOD PHOSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETAMETHASONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETAPACE (SOTALOL) TAB 80MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000065", "type": "CDM"}, {"code": "50268072415", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 8.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BETHANECHOL CHLORIDE INJECT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEVACIZUMAB INJECTION", "code_information": [{"code": "C9257", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEVACIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9035", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BFB TRAINING 1ST 15 MIN", "code_information": [{"code": "90912", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BFB TRAINING EA ADDL 15 MIN", "code_information": [{"code": "90913", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BH LTC RES R&B, PER DIEM", "code_information": [{"code": "T2048", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BHV ID ASSMT BY PHYS/QHP", "code_information": [{"code": "97151", "type": "CPT"}], "standard_charges": [{"minimum": 15.07, "maximum": 15.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BHV ID SUPRT ASSMT BY 1 TECH", "code_information": [{"code": "97152", "type": "CPT"}], "standard_charges": [{"minimum": 11.51, "maximum": 11.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BHV ID SUPRT ASSMT EA 15 MIN", "code_information": [{"code": "362T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIA WHOLE BODY", "code_information": [{"code": "358T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIATAIN ADHESIVE FOAM DRSG 4X4", "code_information": [{"code": "3000088", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIATAIN NON-ADHESIVE FOAM DRSG 4X4", "code_information": [{"code": "3000089", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIAXIN (CLARITHROMYCIN) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000069", "type": "CDM"}, {"code": "00781196160", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 8.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BICARBONATE CONC POW PER PAC", "code_information": [{"code": "A4707", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BICARBONATE CONC SOL PER GAL", "code_information": [{"code": "A4706", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BICILLIN CR 1.2 MMU/2ML INJ", "drug_information": {"unit": 12.0, "type": "EA"}, "code_information": [{"code": "J0558", "type": "HCPCS"}, {"code": "7000071", "type": "CDM"}, {"code": "60793060010", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 191.21, "maximum": 301.91, "gross_charge": 335.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 251.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 268.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 301.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 191.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BICILLIN LA 1.2 MMU/2ML INJ", "drug_information": {"unit": 12.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "72000790", "type": "CDM"}, {"code": "60793070110", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 78.06, "maximum": 123.25, "gross_charge": 136.95, "discounted_cash": 54.17, "estimated_discounted_cash": 149.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 102.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 109.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 123.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 78.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BICILLIN LA 2.4 MMU/4ML INJ", "drug_information": {"unit": 24.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "72000421", "type": "CDM"}, {"code": "60793070210", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 92.76, "maximum": 146.47, "gross_charge": 162.75, "discounted_cash": 54.17, "estimated_discounted_cash": 149.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 122.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 130.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 146.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 92.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIFOC PRSCP LENS", "code_information": [{"code": "S0506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIL HKAF PC S/D MICRO SENSOR", "code_information": [{"code": "K1007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILAT DIL RETINAL EXAM", "code_information": [{"code": "S3000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILAT MAST/HX BI /UNILAT MAS", "code_information": [{"code": "G9708", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILAT MAST/HX BI /UNILAT MAS", "code_information": [{"code": "M1280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [{"code": "461", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [{"code": "462", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS CHOLYLGLYCINE", "code_information": [{"code": "82240", "type": "CPT"}], "standard_charges": [{"minimum": 30.57, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS TOTAL", "code_information": [{"code": "82239", "type": "CPT"}], "standard_charges": [{"minimum": 19.69, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILE DUCT ENDOSCOPY ADD-ON", "code_information": [{"code": "47550", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILE DUCT REVISION", "code_information": [{"code": "47701", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILHARZIASIS", "code_information": [{"code": "87177", "type": "CPT"}, {"code": "1000991", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.24, "maximum": 47.41, "gross_charge": 52.68, "discounted_cash": 54.17, "estimated_discounted_cash": 52.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.14, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDO PERQ DX W/SPECI", "code_information": [{"code": "47552", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47553", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47554", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47555", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47556", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [{"code": "409", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "408", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "410", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN BODY FLUID", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "1000992", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.77, "maximum": 26.73, "gross_charge": 29.7, "discounted_cash": 54.17, "estimated_discounted_cash": 40.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN DIRECT", "code_information": [{"code": "82248", "type": "CPT"}, {"code": "1000136", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.77, "maximum": 26.73, "gross_charge": 29.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "1000138", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.77, "maximum": 26.73, "gross_charge": 29.7, "discounted_cash": 54.17, "estimated_discounted_cash": 40.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL TRANSCUT", "code_information": [{"code": "88720", "type": "CPT"}], "standard_charges": [{"minimum": 5.77, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILOBECTOMY", "code_information": [{"code": "32482", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIO MTRLS TO AID SOFT/OS REG", "code_information": [{"code": "D4265", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIO-CONNEKT PER SQUARE CM", "code_information": [{"code": "Q4161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOCLUSIVE DRESS 4X5", "code_information": [{"code": "3001037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIOCLUSIVE DRESS 5X7", "code_information": [{"code": "3001036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIODFENCE 1CM", "code_information": [{"code": "Q4140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIODFENCE DRYFLEX, 1CM", "code_information": [{"code": "Q4138", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOFEEDBACK TRAIN ANY METH", "code_information": [{"code": "90901", "type": "CPT"}], "standard_charges": [{"minimum": 510.0, "maximum": 510.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOFREEZE 4OZ TUBE", "code_information": [{"code": "3000421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.21, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIOFREEZE COLD THERAPY PAIN RELIEF GEL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003446", "type": "CDM"}, {"code": "59316011520", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 18.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIOIMPEDANCE CV ANALYSIS", "code_information": [{"code": "93701", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOLOGICAL MATERIALS", "code_information": [{"code": "D3431", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPATCH", "code_information": [{"code": "3001435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "478", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "477", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "479", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BIOPSY ABDOMINAL MASS", "code_information": [{"code": "49180", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24065", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24066", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYE MUSCLE", "code_information": [{"code": "67346", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYELID & LID MARGIN", "code_information": [{"code": "67810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26105", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26110", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25065", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25066", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY HAND JOINT LINING", "code_information": [{"code": "26100", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY KNEE JOINT LINING", "code_information": [{"code": "27330", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27613", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27614", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY MUSCLE PERQ NEEDLE", "code_information": [{"code": "20206", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY NAIL UNIT", "code_information": [{"code": "11755", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BOWEL", "code_information": [{"code": "44100", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BREAST OPEN", "code_information": [{"code": "19101", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX", "code_information": [{"code": "57500", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX W/SCOPE", "code_information": [{"code": "57455", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CORNEA", "code_information": [{"code": "65410", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EPIDIDYMIS", "code_information": [{"code": "54800", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EXTERNAL EAR", "code_information": [{"code": "69100", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EXTERNAL EAR CANAL", "code_information": [{"code": "69105", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EYELID LINING", "code_information": [{"code": "68100", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FLOOR OF MOUTH", "code_information": [{"code": "41108", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28050", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28052", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HEART LINING", "code_information": [{"code": "93505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HIP JOINT", "code_information": [{"code": "27052", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LIP", "code_information": [{"code": "40490", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF MOUTH LESION", "code_information": [{"code": "40808", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NECK/CHEST", "code_information": [{"code": "21550", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NERVE", "code_information": [{"code": "64795", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF ORAL TISSUE HARD", "code_information": [{"code": "D7285", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF ORAL TISSUE SOFT", "code_information": [{"code": "D7286", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF OVARY(S)", "code_information": [{"code": "58900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PANCREAS OPEN", "code_information": [{"code": "48100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54100", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54105", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF RECTUM", "code_information": [{"code": "45100", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SACROILIAC JOINT", "code_information": [{"code": "27050", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42400", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42405", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SHOULDER JOINT", "code_information": [{"code": "23100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27040", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27041", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF STOMACH", "code_information": [{"code": "43605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR GLAND", "code_information": [{"code": "68510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR SAC", "code_information": [{"code": "68525", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54500", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54505", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THROAT", "code_information": [{"code": "42800", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THYROID", "code_information": [{"code": "60100", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TOE JOINT LINING", "code_information": [{"code": "28054", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41100", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41105", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42804", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42806", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF URETHRA", "code_information": [{"code": "53200", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UTERUS LINING", "code_information": [{"code": "58100", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56605", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56606", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF WRIST JOINT", "code_information": [{"code": "25100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY", "code_information": [{"code": "89291", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 988.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 988.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY <=5", "code_information": [{"code": "89290", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 785.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 785.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY ROOF OF MOUTH", "code_information": [{"code": "42100", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23065", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23066", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21920", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21925", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TISSUES", "code_information": [{"code": "27323", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TISSUES", "code_information": [{"code": "27324", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY VRT BDY OPEN LMBR/CRV", "code_information": [{"code": "20251", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY VRT BDY OPEN THORACIC", "code_information": [{"code": "20250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38500", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38510", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38520", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38525", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38530", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOTIN 10,000MCG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004338", "type": "CDM"}, {"code": "47469006885", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIOTIN 1000MCG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000782", "type": "CDM"}, {"code": "54629398501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIOTIN FORTE 3MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001126", "type": "CDM"}, {"code": "11822048995", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BIOVANCE 1 SQUARE CM", "code_information": [{"code": "Q4154", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOVANCE TRI OR 3L, SQ CM", "code_information": [{"code": "Q4283", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIPHOS THXPY VEIN ORD/RECVD", "code_information": [{"code": "4100F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIRTHING CLASS", "code_information": [{"code": "S9442", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIS XTRACELL FLUID ANALYSIS", "code_information": [{"code": "93702", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BITE STICK", "code_information": [{"code": "3000090", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BITEWING IMAGE CAPTURE ONLY", "code_information": [{"code": "D0388", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BITEWINGS - THREE IMAGES", "code_information": [{"code": "D0273", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BITEWINGS FOUR IMAGES", "code_information": [{"code": "D0274", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BITOLTEROL MESYLATE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BITOLTEROL MESYLATE COMP UNT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIVALIRUDIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0583", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK IMAGING TST NOT ORDERED", "code_information": [{"code": "3331F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK PAIN & FXN ASSESSED", "code_information": [{"code": "1130F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK PAIN NO VAS", "code_information": [{"code": "G9946", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK PAIN VAS 6-20WK <= 3", "code_information": [{"code": "G2136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK PAIN VAS 6-20WK > 3", "code_information": [{"code": "G2137", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK PAIN VAS 9-15MO <= 3", "code_information": [{"code": "G2138", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK PAIN VAS 9-15MO > 3", "code_information": [{"code": "G2139", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK PN NT MSR VAS SCL PRE/PST", "code_information": [{"code": "G9943", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK PN XM ON INIT VISIT DATE", "code_information": [{"code": "2040F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BK VIRUS QUANT PCR", "code_information": [{"code": "87799", "type": "CPT"}, {"code": "1000824", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 49.27, "maximum": 225.0, "gross_charge": 250.0, "discounted_cash": 54.17, "estimated_discounted_cash": 267.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BK VIRUS QUANT URINE RDM", "code_information": [{"code": "87799", "type": "CPT"}, {"code": "1000986", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 49.27, "maximum": 225.0, "gross_charge": 250.0, "discounted_cash": 54.17, "estimated_discounted_cash": 267.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BKBENCH PREP DON UTER ALGRFT", "code_information": [{"code": "668T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER ARTL", "code_information": [{"code": "670T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER VEN", "code_information": [{"code": "669T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DONOR SEARCH MANAGEMENT", "code_information": [{"code": "38204", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DRAW < 3 YRS FEM/JUGULAR", "code_information": [{"code": "36400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS OTHER VEIN", "code_information": [{"code": "36406", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS SCALP VEIN", "code_information": [{"code": "36405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL SMEAR W/DIFF WBC COUNT", "code_information": [{"code": "85007", "type": "CPT"}], "standard_charges": [{"minimum": 4.37, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL SMEAR W/O DIFF WBC COUNT", "code_information": [{"code": "85008", "type": "CPT"}], "standard_charges": [{"minimum": 3.94, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLADDER CALCULI IRRIG SOL", "code_information": [{"code": "Q2004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLADDER CONTROL PAD LARGE", "code_information": [{"code": "3001346", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLADE CLIPPER SURGICAL", "code_information": [{"code": "3001344", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE SIZE 3 DISPOS. MACINT", "code_information": [{"code": "3001307", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 19.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE SIZE 3 DISPOS. MILLER", "code_information": [{"code": "3001305", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 19.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE SIZE 4 DISPOS. MACINT", "code_information": [{"code": "3001308", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 51.57, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLADE LARYNGOSCOPE SIZE 4 DISPOS. MILLER", "code_information": [{"code": "3001306", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLADE TONGUE NON-STERILE", "code_information": [{"code": "3000091", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLADE TONGUE SR STERILE", "code_information": [{"code": "3000416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLANKET WARMER ADULT", "code_information": [{"code": "3000008", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLANKET WARMER PEDIATRIC", "code_information": [{"code": "3001446", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLASTOMYCES ANTIBODY", "code_information": [{"code": "86612", "type": "CPT"}], "standard_charges": [{"minimum": 14.84, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ NEWBORN", "code_information": [{"code": "36450", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ OTH THN NB", "code_information": [{"code": "36455", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLD PUSH TFUJ 2 YR/<", "code_information": [{"code": "36440", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLD TYPING SEROLOGIC RH PHNT", "code_information": [{"code": "86906", "type": "CPT"}], "standard_charges": [{"minimum": 8.91, "maximum": 13.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLEEDING TIME TEST", "code_information": [{"code": "85002", "type": "CPT"}], "standard_charges": [{"minimum": 5.54, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLEOMYCIN SULFATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLIND COR SINUS REDUCER IMPL", "code_information": [{"code": "C9783", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLIND INTERATRIAL SHUNT IDE", "code_information": [{"code": "C9758", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLIND MYOCAR TRPL BON MARROW", "code_information": [{"code": "C9782", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLIND/NONBLIND TRANS ATRIAL", "code_information": [{"code": "C9792", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLINDED CONV. TX MDD CLIN TR", "code_information": [{"code": "G2000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLINK REFLEX TEST", "code_information": [{"code": "95933", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLM GENE", "code_information": [{"code": "81209", "type": "CPT"}], "standard_charges": [{"minimum": 45.21, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT LYSIS TIME", "code_information": [{"code": "85175", "type": "CPT"}], "standard_charges": [{"minimum": 11.82, "maximum": 23.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT RETRACTION", "code_information": [{"code": "85170", "type": "CPT"}], "standard_charges": [{"minimum": 11.82, "maximum": 18.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD COLLECTION TUBE/VACUUM", "code_information": [{"code": "A4770", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD COMPONENT/PRODUCT NOC", "code_information": [{"code": "P9099", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD CULTURE & SENSITIVITY", "code_information": [{"code": "87040", "type": "CPT"}, {"code": "1000681", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.87, "maximum": 87.73, "gross_charge": 61.11, "discounted_cash": 54.17, "estimated_discounted_cash": 61.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 48.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 54.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 34.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD DRAW", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1001004", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.26, "maximum": 16.2, "gross_charge": 18.0, "discounted_cash": 54.17, "estimated_discounted_cash": 11.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD FUNGUS CULTURE", "code_information": [{"code": "87103", "type": "CPT"}], "standard_charges": [{"minimum": 23.53, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD GAS KIT", "code_information": [{"code": "3000417", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BLOOD GASES O2 SAT ONLY", "code_information": [{"code": "82810", "type": "CPT"}], "standard_charges": [{"minimum": 11.24, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES W/O2 SATURATION", "code_information": [{"code": "82805", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 90.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD GLUCOSE LEVEL TEST", "code_information": [{"code": "D0412", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD GLUCOSE TEST STRIPS", "code_information": [{"code": "A4772", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD KETONE TEST OR STRIP", "code_information": [{"code": "A4252", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD MUCOPROTEIN", "code_information": [{"code": "P2038", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.64, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD PH", "code_information": [{"code": "82800", "type": "CPT"}], "standard_charges": [{"minimum": 12.65, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD PLATELET AGGREGATION", "code_information": [{"code": "85576", "type": "CPT"}], "standard_charges": [{"minimum": 28.65, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD PRESSURE CHECK -EST PT", "code_information": [{"code": "99211", "type": "CPT"}, {"code": "11000250", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 97.07, "maximum": 153.27, "gross_charge": 170.31, "discounted_cash": 54.17, "estimated_discounted_cash": 155.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 127.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 136.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 153.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 97.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PRESSURE MEASURE", "code_information": [{"code": "2000F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD PRODUCT/IRRADIATION", "code_information": [{"code": "86945", "type": "CPT"}], "standard_charges": [{"minimum": 13.73, "maximum": 30.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD SMEAR INTERPRETATION", "code_information": [{"code": "85060", "type": "CPT"}], "standard_charges": [{"minimum": 27.15, "maximum": 27.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD SPLIT UNIT", "code_information": [{"code": "P9011", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD THYMOL TURBIDITY", "code_information": [{"code": "P2033", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.73, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING ANTIGEN SYSTEM", "code_information": [{"code": "86911", "type": "CPT"}], "standard_charges": [{"minimum": 13.73, "maximum": 22.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATERNITY TEST", "code_information": [{"code": "86910", "type": "CPT"}], "standard_charges": [{"minimum": 13.73, "maximum": 26.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATIENT SERUM", "code_information": [{"code": "86904", "type": "CPT"}], "standard_charges": [{"minimum": 13.73, "maximum": 18.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD UREA NITROGEN", "code_information": [{"code": "84520", "type": "CPT"}, {"code": "1000213", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.54, "maximum": 21.03, "gross_charge": 23.37, "discounted_cash": 54.17, "estimated_discounted_cash": 23.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 13.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD VISCOSITY EXAMINATION", "code_information": [{"code": "85810", "type": "CPT"}], "standard_charges": [{"minimum": 13.42, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD VOLUME", "code_information": [{"code": "78122", "type": "CPT"}], "standard_charges": [{"minimum": 122.33, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 122.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD, L/R, CMV-NEG", "code_information": [{"code": "P9051", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD, L/R, FROZ/DEGLY/WASH", "code_information": [{"code": "P9054", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD, L/R, IRRADIATED", "code_information": [{"code": "P9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLS", "code_information": [{"code": "A0428", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLS DEFIBRILLATION SUPPLIES", "code_information": [{"code": "A0384", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLS-EMERGENCY", "code_information": [{"code": "A0429", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLUE LIGHT CYSTO IMAG AGENT", "code_information": [{"code": "C9738", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BMI DOC ONL FUP NOT CMPLTD", "code_information": [{"code": "G9716", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BMI DOC ONL FUP NOT CMPLTD", "code_information": [{"code": "M1286", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BMI NOT CALCULATED", "code_information": [{"code": "G8421", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BMI NOT CALCULATED", "code_information": [{"code": "M1314", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BMI NOT DOC MEDRSN PTREF", "code_information": [{"code": "G2181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BMI NOT DOC MEDRSN PTREF", "code_information": [{"code": "M1297", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BMT HARV/TRANSPL 28D PKG", "code_information": [{"code": "S2150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BN DEN 2YR/GOT OST MED/THER", "code_information": [{"code": "G9769", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BODY FLUID SPECIFIC GRAVITY", "code_information": [{"code": "84315", "type": "CPT"}], "standard_charges": [{"minimum": 3.77, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BODY MASS INDEX DOCD", "code_information": [{"code": "3008F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BODY-WORN BILAT HEARING AID", "code_information": [{"code": "V5100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BODY-WORN BINAUR HEARING AID", "code_information": [{"code": "V5120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BODY-WORN HEARING AID AIR", "code_information": [{"code": "V5030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BODY-WORN HEARING AID BONE", "code_information": [{"code": "V5040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY OPEN DEEP", "code_information": [{"code": "20245", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY OPEN SUPERFICIAL", "code_information": [{"code": "20240", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY TROCAR/NDL DEEP", "code_information": [{"code": "20225", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY TROCAR/NDL SUPFC", "code_information": [{"code": "20220", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING BODY MANDIBLE", "code_information": [{"code": "D7945", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING RAMUS CLOSED", "code_information": [{"code": "D7941", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING SEGMENTED", "code_information": [{"code": "D7944", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE DENSITY DO NOT CHARGE", "code_information": [{"code": "2000122", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [{"code": "553", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [{"code": "554", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 2469.22, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT PERI EACH ADDL", "code_information": [{"code": "D3429", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT PERI PER TOOTH", "code_information": [{"code": "D3428", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT REPAIR PERIMPLANT", "code_information": [{"code": "D6103", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT TIME OF IMPLANT", "code_information": [{"code": "D6104", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE HARVEST,AUTO GRAFT PROC", "code_information": [{"code": "D7295", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING 3 PHASE", "code_information": [{"code": "78315", "type": "CPT"}], "standard_charges": [{"minimum": 411.62, "maximum": 411.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 411.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING LIMITED AREA", "code_information": [{"code": "78300", "type": "CPT"}], "standard_charges": [{"minimum": 271.78, "maximum": 271.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 271.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING MULTIPLE AREAS", "code_information": [{"code": "78305", "type": "CPT"}], "standard_charges": [{"minimum": 328.06, "maximum": 328.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 328.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING WHOLE BODY", "code_information": [{"code": "78306", "type": "CPT"}], "standard_charges": [{"minimum": 352.69, "maximum": 352.69, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 352.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIR BONE GRFG", "code_information": [{"code": "20939", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST ALLOGEN", "code_information": [{"code": "38230", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST AUTOLOG", "code_information": [{"code": "38232", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING BODY", "code_information": [{"code": "78104", "type": "CPT"}], "standard_charges": [{"minimum": 298.44, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 298.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING LTD", "code_information": [{"code": "78102", "type": "CPT"}], "standard_charges": [{"minimum": 205.84, "maximum": 205.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 205.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING MULT", "code_information": [{"code": "78103", "type": "CPT"}], "standard_charges": [{"minimum": 227.2, "maximum": 227.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 227.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MARROW INTERPRETATION", "code_information": [{"code": "85097", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 53.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL DUAL PHOTON", "code_information": [{"code": "78351", "type": "CPT"}], "standard_charges": [{"minimum": 19.85, "maximum": 19.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL SINGLE PHOTON", "code_information": [{"code": "78350", "type": "CPT"}], "standard_charges": [{"minimum": 39.76, "maximum": 39.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE REPLACEMENT GRAFT", "code_information": [{"code": "D7953", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE REPLCE GRAFT EACH ADD", "code_information": [{"code": "D4264", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE REPLCE GRAFT FIRST SITE", "code_information": [{"code": "D4263", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE SCN B/4 TXMNT/AFTR DX", "code_information": [{"code": "3269F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE SPECIFIC ALKALINE PHOSPHASE", "code_information": [{"code": "84080", "type": "CPT"}, {"code": "1000630", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 78.78, "gross_charge": 87.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 70.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR CT/MRI IMAG", "code_information": [{"code": "55T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR FLUOR IMAGE", "code_information": [{"code": "54T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT ILIAC CREST", "code_information": [{"code": "20970", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT METATARSAL", "code_information": [{"code": "20972", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT MICROVASC", "code_information": [{"code": "20969", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BOOST BREEZE ORANGE", "code_information": [{"code": "80001198", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BOOST CHOCOLATE", "code_information": [{"code": "80001225", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BOOST STRAWBERRY", "code_information": [{"code": "80001222", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BOOST VERY HIGH CALORIE", "code_information": [{"code": "80001224", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BOOST VERY VANILLA", "code_information": [{"code": "80001201", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BORDETELLA PERTUSSIS CULTURE", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "1000831", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.91, "maximum": 45.87, "gross_charge": 50.97, "discounted_cash": 54.17, "estimated_discounted_cash": 50.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA ANTIBODY", "code_information": [{"code": "86619", "type": "CPT"}], "standard_charges": [{"minimum": 15.39, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BORRELIA MIYAMOTOI AMP PRB", "code_information": [{"code": "87478", "type": "CPT"}], "standard_charges": [{"minimum": 41.06, "maximum": 41.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BOTTLE HOT WATER GRA", "code_information": [{"code": "3000093", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BOTTLE INFANT 8OZ", "code_information": [{"code": "3000094", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BOTULINUM ANTITOXIN", "code_information": [{"code": "90287", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BOTULISM IG IV", "code_information": [{"code": "90288", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BOWEL TO BOWEL FUSION", "code_information": [{"code": "44130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BOWL SOLUTION 32OZ", "code_information": [{"code": "3000095", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BP NOT PERFORMED/DOC", "code_information": [{"code": "G8478", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP OUT OF NRML LIMITS", "code_information": [{"code": "G9274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SCRN NO PERF AT INTERVAL", "code_information": [{"code": "G8785", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SCRN NO PERF AT INTERVAL", "code_information": [{"code": "M1281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SCRN PERF REC INTERVAL", "code_information": [{"code": "G8783", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SCRN PERF REC INTERVAL", "code_information": [{"code": "M1294", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SYS <140 AND DIAS <90", "code_information": [{"code": "G8476", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SYS>=140 AND/OR DIAS >=90", "code_information": [{"code": "G8477", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BPCI ADVANCED IN HOME VISIT", "code_information": [{"code": "G9987", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BPCI HOME VISIT", "code_information": [{"code": "G9187", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACE COUCIATE BACK", "code_information": [{"code": "3000096", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 512.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BRACE KNEE SUPPORT E", "code_information": [{"code": "3000097", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BRACE POST-OP KNEE M", "code_information": [{"code": "3000098", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 123.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BRACE POST-OP KNEE X", "code_information": [{"code": "3000099", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 123.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BRACHY LINEAR, NON-STR,P-103", "code_information": [{"code": "C2636", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHY,NON-STR,YTTERBIUM-169", "code_information": [{"code": "C2637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTHERAPY NEEDLE", "code_information": [{"code": "C1715", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTHERAPY RADIOELEMENTS", "code_information": [{"code": "Q3001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX CESIUM-131 CHLORIDE", "code_information": [{"code": "C2644", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE COMPLEX", "code_information": [{"code": "77318", "type": "CPT"}], "standard_charges": [{"minimum": 375.16, "maximum": 732.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 732.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 375.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE INTERMED", "code_information": [{"code": "77317", "type": "CPT"}], "standard_charges": [{"minimum": 375.16, "maximum": 515.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 515.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 375.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77316", "type": "CPT"}], "standard_charges": [{"minimum": 389.8, "maximum": 389.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 389.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX PLANAR, P-103", "code_information": [{"code": "C2645", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, GOLD-198", "code_information": [{"code": "C1716", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, HA, I-125", "code_information": [{"code": "C2634", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, HA, P-103", "code_information": [{"code": "C2635", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR,HDR IR-192", "code_information": [{"code": "C1717", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR,YTTRIUM-90", "code_information": [{"code": "C2616", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED, NOS", "code_information": [{"code": "C2699", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,C-131", "code_information": [{"code": "C2643", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,I-125", "code_information": [{"code": "C2639", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,P-103", "code_information": [{"code": "C2641", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NS, NON-HDRIR-192", "code_information": [{"code": "C1719", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, C-131", "code_information": [{"code": "C2642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, I-125", "code_information": [{"code": "C2638", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, NOS", "code_information": [{"code": "C2698", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, P-103", "code_information": [{"code": "C2640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAF GENE", "code_information": [{"code": "81210", "type": "CPT"}], "standard_charges": [{"minimum": 201.71, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61697", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61698", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR SIMPLE", "code_information": [{"code": "61700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN BIOPSY W/CT/MR GUIDE", "code_information": [{"code": "61751", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN CANAL SHUNT PROCEDURE", "code_information": [{"code": "61070", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN CAVITY SHUNT W/SCOPE", "code_information": [{"code": "62201", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN FLOW IMAGING ONLY", "code_information": [{"code": "78610", "type": "CPT"}], "standard_charges": [{"minimum": 207.42, "maximum": 207.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 207.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE 4+ VIEWS", "code_information": [{"code": "78605", "type": "CPT"}], "standard_charges": [{"minimum": 238.51, "maximum": 238.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE < 4 VIEWS", "code_information": [{"code": "78600", "type": "CPT"}], "standard_charges": [{"minimum": 218.95, "maximum": 218.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 218.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW 4 + VIEWS", "code_information": [{"code": "78606", "type": "CPT"}], "standard_charges": [{"minimum": 388.48, "maximum": 388.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 388.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW < 4 VIEWS", "code_information": [{"code": "78601", "type": "CPT"}], "standard_charges": [{"minimum": 256.24, "maximum": 256.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 256.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78608", "type": "CPT"}], "standard_charges": [{"minimum": 855.76, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 855.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78609", "type": "CPT"}], "standard_charges": [{"minimum": 45.54, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN NATUTERIC PEPTIDE", "code_information": [{"code": "83880", "type": "CPT"}, {"code": "1000310", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 43.69, "maximum": 102.04, "gross_charge": 76.65, "discounted_cash": 54.17, "estimated_discounted_cash": 77.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 BRCA2 MRNA SEQ ALYS", "code_information": [{"code": "138U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81166", "type": "CPT"}], "standard_charges": [{"minimum": 346.55, "maximum": 346.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 346.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL SEQ ALYS", "code_information": [{"code": "81165", "type": "CPT"}], "standard_charges": [{"minimum": 325.31, "maximum": 325.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 325.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81215", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 431.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 431.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 185&5385&6174 VRNT", "code_information": [{"code": "81212", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 506.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 506.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FUL DUP/DEL ALYS", "code_information": [{"code": "81164", "type": "CPT"}], "standard_charges": [{"minimum": 671.86, "maximum": 671.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 671.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FULL SEQ DUP/DEL", "code_information": [{"code": "81162", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 2098.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2098.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GENE FULL SEQ ALYS", "code_information": [{"code": "81163", "type": "CPT"}], "standard_charges": [{"minimum": 538.2, "maximum": 538.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 538.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81167", "type": "CPT"}], "standard_charges": [{"minimum": 325.31, "maximum": 325.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 325.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL SEQ ALYS", "code_information": [{"code": "81216", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 212.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81217", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 431.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 431.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST \"\"STACKED\"\" DIEP/GAP", "code_information": [{"code": "S2067", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST AUGMENTATION W/IMPLT", "code_information": [{"code": "19325", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC", "code_information": [{"code": "584", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "585", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BREAST CANCER DX MIN INVSIVE", "code_information": [{"code": "G8875", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST DIEP OR SIEA FLAP", "code_information": [{"code": "S2068", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST GAP FLAP RECONST", "code_information": [{"code": "S2066", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST MILK PROC/STORE/DIST", "code_information": [{"code": "T2101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS NOS", "code_information": [{"code": "L8039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST RECONSTRUCTION", "code_information": [{"code": "19350", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST REDUCTION", "code_information": [{"code": "19318", "type": "CPT"}], "standard_charges": [{"minimum": 21736.36, "maximum": 21736.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 21736.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77062", "type": "CPT"}], "standard_charges": [{"minimum": 161.54, "maximum": 202.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 202.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77063", "type": "CPT"}], "standard_charges": [{"minimum": 67.92, "maximum": 161.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS UNI", "code_information": [{"code": "77061", "type": "CPT"}], "standard_charges": [{"minimum": 160.3, "maximum": 161.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREATH HYDROGEN/METHANE TEST", "code_information": [{"code": "91065", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREATH RECORDING INFANT", "code_information": [{"code": "94772", "type": "CPT"}], "standard_charges": [{"minimum": 326.52, "maximum": 326.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 326.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREATH TEST ANALYSIS C-14", "code_information": [{"code": "78268", "type": "CPT"}], "standard_charges": [{"minimum": 102.04, "maximum": 108.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 108.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREATH TST ATTAIN/ANAL C-14", "code_information": [{"code": "78267", "type": "CPT"}], "standard_charges": [{"minimum": 12.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRENTUXIMAB VEDOTIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9042", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREO ELLIPTA INH PWD 100MCG-25MCG/1AC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001761", "type": "CDM"}, {"code": "00173085914", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 408.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BRETHINE (TERBUTALINE) INJ 1MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3105", "type": "HCPCS"}, {"code": "7000073", "type": "CDM"}, {"code": "55390010110", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 28.89, "maximum": 45.63, "gross_charge": 50.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 28.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRETT'S BUTT PASTE (CHOLESTYRAMINE PWD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001112", "type": "CDM"}, {"code": "49884046566", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BREXUCABTAGENE CAR POS T", "code_information": [{"code": "Q2053", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE BASE METAL CAST", "code_information": [{"code": "D6211", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE NOBLE METAL CAST", "code_information": [{"code": "D6212", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN BASE METAL", "code_information": [{"code": "D6241", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN HIGH NOBLE", "code_information": [{"code": "D6240", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN NOBEL METAL", "code_information": [{"code": "D6242", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN/CERAMIC", "code_information": [{"code": "D6245", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN BASE METAL", "code_information": [{"code": "D6251", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN W/HIGH NOBLE", "code_information": [{"code": "D6250", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN W/NOBLE METAL", "code_information": [{"code": "D6252", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIEF ALCOHOL MISUSE COUNSEL", "code_information": [{"code": "G0443", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.86, "maximum": 76.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN BY MD/QHP, 11-20", "code_information": [{"code": "G2252", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN, 5-10, NON-E/M", "code_information": [{"code": "G2251", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIEF EMOTIONAL/BEHAV ASSMT", "code_information": [{"code": "96127", "type": "CPT"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRILINTA (TICAGRELOR) Tablet 90MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002553", "type": "CDM"}, {"code": "42658011503", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PLM NRV UNI", "code_information": [{"code": "782T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PULM NRV BI", "code_information": [{"code": "781T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR 1ST", "code_information": [{"code": "31645", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR SBSQ", "code_information": [{"code": "31646", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BROMFED DM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000983", "type": "CDM"}, {"code": "00121093316", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BROMPHENIRAMINE MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0945", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS IVNTJ PERPH LES", "code_information": [{"code": "31654", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 1/2 NODE", "code_information": [{"code": "31652", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 3/> NODE", "code_information": [{"code": "31653", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH LAVAGE W/EBUS", "code_information": [{"code": "C7556", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 1 LOBE", "code_information": [{"code": "31660", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 2/> LOBES", "code_information": [{"code": "31661", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH W RX ANTIBX 30D", "code_information": [{"code": "G2177", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH W/BALLOON OCCLUSION", "code_information": [{"code": "31634", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ EBUS", "code_information": [{"code": "C7512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ NAVIGATION", "code_information": [{"code": "C7511", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH/LAVAG W/ NAVIGATION", "code_information": [{"code": "C7510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL ALLERGY TESTS", "code_information": [{"code": "95070", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL BRUSH BIOPSY", "code_information": [{"code": "31717", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE ADDL INSERT", "code_information": [{"code": "31651", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE INIT INSERT", "code_information": [{"code": "31647", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV ADDL", "code_information": [{"code": "31649", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV INIT", "code_information": [{"code": "31648", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [{"code": "202", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 5240.2, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [{"code": "203", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY BRONCH STENTS", "code_information": [{"code": "31636", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE W/STENT", "code_information": [{"code": "31631", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE/FX REPR", "code_information": [{"code": "31630", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY REVISE STENT", "code_information": [{"code": "31638", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY STENT ADD-ON", "code_information": [{"code": "31637", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY TREAT BLOCKAGE", "code_information": [{"code": "31641", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/BIOPSY(S)", "code_information": [{"code": "31625", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/FB REMOVAL", "code_information": [{"code": "31635", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/MARKERS", "code_information": [{"code": "31626", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/TUMOR EXCISE", "code_information": [{"code": "31640", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX ADDL", "code_information": [{"code": "31632", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX EACH", "code_information": [{"code": "31628", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX ADDL", "code_information": [{"code": "31633", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX EACH", "code_information": [{"code": "31629", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BROVANA (ARFORMOTEROL) AH 15MCG/2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7605", "type": "HCPCS"}, {"code": "72004326", "type": "CDM"}, {"code": "43598077730", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 3.71, "maximum": 5.85, "gross_charge": 6.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 3.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST CNCR STAGE > T1N0M0", "code_information": [{"code": "G8881", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1 PDCL TRAM FLAP", "code_information": [{"code": "19367", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1PDCL TRAM ANAST", "code_information": [{"code": "19368", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 2 PDCL TRAM FLAP", "code_information": [{"code": "19369", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ FREE FLAP", "code_information": [{"code": "19364", "type": "CPT"}], "standard_charges": [{"minimum": 21736.36, "maximum": 21736.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 21736.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ LATSMS DRSI FLAP", "code_information": [{"code": "19361", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRT CA DX I, NO T1/T1A/T1B", "code_information": [{"code": "G9832", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRUCELLA ANTIBODY", "code_information": [{"code": "86622", "type": "CPT"}], "standard_charges": [{"minimum": 10.27, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRUSH BIOPSY", "code_information": [{"code": "D7288", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRUSH HAIR", "code_information": [{"code": "3000009", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BRUSH/HAIR", "code_information": [{"code": "3001424", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BSO OMENTECTOMY W/TAH", "code_information": [{"code": "58956", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BTK GENE COMMON VARIANTS", "code_information": [{"code": "81233", "type": "CPT"}], "standard_charges": [{"minimum": 201.71, "maximum": 201.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUCCAL/LABIAL FRENECTOMY", "code_information": [{"code": "D7961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7634", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7633", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUMEX (BUMETANIDE) 0.25MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000668", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BUMEX (BUMETANIDE) TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001025", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BUMEX TAB 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000748", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BUNDLE OF HIS RECORDING", "code_information": [{"code": "93600", "type": "CPT"}], "standard_charges": [{"minimum": 19778.37, "maximum": 19778.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19778.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPIVACAINE IMPLANT, 1 MG", "code_information": [{"code": "C9089", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPREN/NAL 3.1 TO 6MG BUPREN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0573", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPREN/NAL 6.1 TO 10MG BUPRE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0574", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPREN/NAL OVER 10MG BUPRENO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0575", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPREN/NAL UP TO 3MG BUPRENO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0572", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPRENORPH XR 100 MG OR LESS", "code_information": [{"code": "Q9991", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPRENORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0592", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPRENORPHINE IMPLANT 74.2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0570", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPRENORPHINE ORAL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0571", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPRENORPHINE XR OVER 100 MG", "code_information": [{"code": "Q9992", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUPROPION HCL SR 60 TABLETS", "code_information": [{"code": "S0106", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BURN TREATMENT INITAL TECH", "code_information": [{"code": "16000", "type": "CPT"}, {"code": "11000024", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURN TREATMENT LARGE TECH", "code_information": [{"code": "16030", "type": "CPT"}, {"code": "11000027", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURN TREATMENT MEDIUM TECH", "code_information": [{"code": "16025", "type": "CPT"}, {"code": "11000029", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURN TREATMENT SMALL TECH", "code_information": [{"code": "16020", "type": "CPT"}, {"code": "11000031", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR HOLE FOR PUNCTURE", "code_information": [{"code": "61120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUSPAR (BUSPIRONE HCL) Tablet 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002703", "type": "CDM"}, {"code": "00904712261", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BUSPAR (BUSPIRONE) TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000075", "type": "CDM"}, {"code": "51079096020", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BUSPAR (NF-busPIRone) Tablet 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002140", "type": "CDM"}, {"code": "51079099420", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BUSULFAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0594", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUTORPHANOL TARTRATE, NASAL", "code_information": [{"code": "S0012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUTRANS (BUPRENORPHINE) PATCH 5MCG/HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004271", "type": "CDM"}, {"code": "50742037204", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 116.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY", "code_information": [{"code": "27027", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY W/DBRDMT", "code_information": [{"code": "27057", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION MR IMAG", "code_information": [{"code": "19085", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION STRTCTC", "code_information": [{"code": "19081", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION US IMAG", "code_information": [{"code": "19083", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION MR IMAG", "code_information": [{"code": "19086", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION STRTCTC", "code_information": [{"code": "19082", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION US IMAG", "code_information": [{"code": "19084", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX BREAST PERCUT W/O IMAGE", "code_information": [{"code": "19100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX DONE W/COLPOSCOPY ADD-ON", "code_information": [{"code": "58110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57460", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/CURETT OF CERVIX W/SCOPE", "code_information": [{"code": "57454", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN CERVL", "code_information": [{"code": "63285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRC", "code_information": [{"code": "63286", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRLMB", "code_information": [{"code": "63287", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN CRVL", "code_information": [{"code": "63280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN LMBR", "code_information": [{"code": "63282", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN SCRL", "code_information": [{"code": "63283", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN THRC", "code_information": [{"code": "63281", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN CRVL", "code_information": [{"code": "63275", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN LMBR", "code_information": [{"code": "63277", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN SCRL", "code_information": [{"code": "63278", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN THRC", "code_information": [{"code": "63276", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL/IDRL LSN ANY LVL", "code_information": [{"code": "63290", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BYDUREON PEN 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001056", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BYPASS GRAFT PATENCY/PATCH", "code_information": [{"code": "35685", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT/AV FIST PATENCY", "code_information": [{"code": "35686", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BYSTOLIC (NEBIVOLOL) 2.5MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003175", "type": "CDM"}, {"code": "59651013730", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 14.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BYSTOLIC (NEBIVOLOL) 20MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001279", "type": "CDM"}, {"code": "59651014030", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "BYSTOLIC (NEBIVOLOL) 5MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000906", "type": "CDM"}, {"code": "43547052503", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Beta-amyloid; 1-40 (Abeta 40)", "code_information": [{"code": "82233", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Beta-amyloid; 1-42 (Abeta 42)", "code_information": [{"code": "82234", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation", "code_information": [{"code": "98016", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Bronchoscopy, rigid or flexible, non-thermal transbronchial ablation of lesion(s) by pulsed electric field (PEF) energy, including fluoroscopic and/or ultrasound guidance, when performed, with computed tomography acquisition(s) and 3D rendering, computer-", "code_information": [{"code": "C8005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C DIFF TOX AG DETCJ IA STOOL", "code_information": [{"code": "107U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED LWR LIMBS", "code_information": [{"code": "95929", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED UPPR LIMBS", "code_information": [{"code": "95928", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED UPR&LWR LIMBS", "code_information": [{"code": "95939", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C PEPTIDE", "code_information": [{"code": "84681", "type": "CPT"}, {"code": "1000162", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 23.93, "maximum": 110.83, "gross_charge": 123.15, "discounted_cash": 54.17, "estimated_discounted_cash": 123.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 98.52, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 110.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 70.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C REACTIVE PROTEIN", "code_information": [{"code": "86140", "type": "CPT"}, {"code": "1000321", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 33.38, "gross_charge": 30.63, "discounted_cash": 54.17, "estimated_discounted_cash": 30.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-1 ESTERASE, BERINERT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0597", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-1 ESTERASE, CINRYZE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0598", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-LAMINOPLASTY W/GRAFT/PLATE", "code_information": [{"code": "63051", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG CORNEOSCLRL LENS", "code_information": [{"code": "92313", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA 1", "code_information": [{"code": "92315", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA OU", "code_information": [{"code": "92316", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH CORNEOSCLRL", "code_information": [{"code": "92317", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH OU", "code_information": [{"code": "92314", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-TELOPEPTIDE - SERUM", "code_information": [{"code": "82523", "type": "CPT"}, {"code": "1000728", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.48, "maximum": 99.57, "gross_charge": 110.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 63.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C2 COMPLEMENT", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "1000592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.8, "maximum": 63.96, "gross_charge": 71.07, "discounted_cash": 54.17, "estimated_discounted_cash": 71.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C3", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "1000331", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.8, "maximum": 63.96, "gross_charge": 71.07, "discounted_cash": 54.17, "estimated_discounted_cash": 71.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C4", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "1000332", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.8, "maximum": 63.96, "gross_charge": 71.07, "discounted_cash": 54.17, "estimated_discounted_cash": 71.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA 125", "code_information": [{"code": "86304", "type": "CPT"}, {"code": "1000124", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 23.93, "maximum": 110.86, "gross_charge": 123.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 98.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 110.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 70.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA 15-3", "code_information": [{"code": "86300", "type": "CPT"}, {"code": "1000123", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 23.93, "maximum": 110.86, "gross_charge": 123.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 98.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 110.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 70.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA 27.29", "code_information": [{"code": "86300", "type": "CPT"}, {"code": "1000028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 23.93, "maximum": 110.86, "gross_charge": 123.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 98.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 110.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 70.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;FLEXI SIGMOIDSCOPE", "code_information": [{"code": "G0104", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;PELVIC/BREAST EXAM", "code_information": [{"code": "G0101", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CA TX E-STIM ELECTR/TRANSDUC", "code_information": [{"code": "A4555", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABAZITAXEL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9043", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABERGOLINE, ORAL 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ART-VEIN SIX OR MORE", "code_information": [{"code": "33523", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL FOUR OR MORE", "code_information": [{"code": "33536", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL SINGLE", "code_information": [{"code": "33533", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL THREE", "code_information": [{"code": "33535", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL TWO", "code_information": [{"code": "33534", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FIVE", "code_information": [{"code": "33522", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FOUR", "code_information": [{"code": "33521", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN SINGLE", "code_information": [{"code": "33517", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN THREE", "code_information": [{"code": "33519", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN TWO", "code_information": [{"code": "33518", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FIVE", "code_information": [{"code": "33514", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FOUR", "code_information": [{"code": "33513", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SINGLE", "code_information": [{"code": "33510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SIX OR MORE", "code_information": [{"code": "33516", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN THREE", "code_information": [{"code": "33512", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN TWO", "code_information": [{"code": "33511", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CACNA1A FULL GENE ANALYSIS", "code_information": [{"code": "231U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN DETC ABNOR ALLEL", "code_information": [{"code": "81184", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN KNOWN FAMIL VRNT", "code_information": [{"code": "81186", "type": "CPT"}], "standard_charges": [{"minimum": 212.98, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CACNA1A GENE FULL GENE SEQ", "code_information": [{"code": "81185", "type": "CPT"}], "standard_charges": [{"minimum": 973.21, "maximum": 973.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 973.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAD BREAST MRI", "code_information": [{"code": "C8937", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAD CXR REMOTE", "code_information": [{"code": "175T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAD CXR WITH INTERP", "code_information": [{"code": "174T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CADUET TAB 10/20", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000369", "type": "CDM"}, {"code": "00069218030", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 18.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAFFEINE CITRATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0706", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALAN (NF-Verapamil HCl) Tablet 120MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002815", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALAN (VERAPAMIL HCL) ER CAP 120MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000482", "type": "CDM"}, {"code": "68462029201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALAN (VERAPAMIL HCL) ER TAB 180MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000484", "type": "CDM"}, {"code": "68462029301", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALAN (VERAPAMIL) 2.5MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "7000483", "type": "CDM"}, {"code": "70710164305", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"minimum": 46.13, "maximum": 72.84, "gross_charge": 80.94, "discounted_cash": 54.17, "estimated_discounted_cash": 30.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 60.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALAZIME PROTECTANT PASTE", "code_information": [{"code": "3000010", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALC BMI ABV UP PARAM F/U", "code_information": [{"code": "G8417", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI ABV UP PARAM F/U", "code_information": [{"code": "M1293", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI BLW LOW PARAM F/U", "code_information": [{"code": "G8418", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI BLW LOW PARAM F/U", "code_information": [{"code": "M1287", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI NORM PARAMETERS", "code_information": [{"code": "G8420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI NORM PARAMETERS", "code_information": [{"code": "M1296", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI OUT NRM PARAM NOF/U", "code_information": [{"code": "G8419", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI OUT NRM PARAM NOF/U", "code_information": [{"code": "M1276", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCET (CALCIUM/VIT D) TAB 200MG/250IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000077", "type": "CDM"}, {"code": "01780025101", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALCITONIN (SERUM)", "code_information": [{"code": "82308", "type": "CPT"}, {"code": "1000080", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 30.81, "maximum": 142.66, "gross_charge": 158.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 142.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 90.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCITONIN SALMON INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0630", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCITONIN STIMUL PANEL", "code_information": [{"code": "80410", "type": "CPT"}], "standard_charges": [{"minimum": 92.43, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 92.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCITRIOL 0.25MCG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000452", "type": "CDM"}, {"code": "23155066203", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALCITROL", "code_information": [{"code": "S0169", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCIUM", "code_information": [{"code": "82310", "type": "CPT"}, {"code": "1000139", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.93, "maximum": 27.45, "gross_charge": 30.51, "discounted_cash": 54.17, "estimated_discounted_cash": 30.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM + D (CITRACAL) TAB 600MG/400IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000245", "type": "CDM"}, {"code": "20555001700", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALCIUM 24HR UR", "code_information": [{"code": "82340", "type": "CPT"}, {"code": "1000283", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.93, "maximum": 38.72, "gross_charge": 35.7, "discounted_cash": 54.17, "estimated_discounted_cash": 35.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM CHLORIDE 10% SYR 1GM/10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000499", "type": "CDM"}, {"code": "76329330401", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALCIUM CITRATE 200MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003154", "type": "CDM"}, {"code": "80681014000", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CALCIUM GLUCON (WG CRITICAL)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCIUM GLUCONATE 1000MG/10ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0612", "type": "HCPCS"}, {"code": "7200076", "type": "CDM"}, {"code": "63323036019", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM GLYCER & LACT/10 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCIUM INFUSION TEST", "code_information": [{"code": "82331", "type": "CPT"}], "standard_charges": [{"minimum": 15.34, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCIUM IONIZED", "code_information": [{"code": "82330", "type": "CPT"}, {"code": "1000291", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.73, "maximum": 72.79, "gross_charge": 80.88, "discounted_cash": 54.17, "estimated_discounted_cash": 80.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCULUS ANALYSIS QUAL", "code_information": [{"code": "82355", "type": "CPT"}], "standard_charges": [{"minimum": 13.32, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCULUS ASSAY QUANT", "code_information": [{"code": "82360", "type": "CPT"}], "standard_charges": [{"minimum": 14.8, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALIBRATED MICROCAP TUBE", "code_information": [{"code": "A4651", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALORIC VESTIBULAR TEST", "code_information": [{"code": "92533", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALORIC VSTBLR TEST W/REC", "code_information": [{"code": "92537", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALORIC VSTBLR TEST W/REC", "code_information": [{"code": "92538", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALR GENE COM VARIANTS", "code_information": [{"code": "81219", "type": "CPT"}], "standard_charges": [{"minimum": 139.87, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 139.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALTRATE (CALCIUM CARBONATE) 600MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001670", "type": "CDM"}, {"code": "80681000500", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAM CERVIX UTERI DRG COLP", "code_information": [{"code": "57465", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAMISOLE POST-MAST", "code_information": [{"code": "S8460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAMP DAY WAIVER/SESSION", "code_information": [{"code": "T2037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAMP OVERNITE WAIVER/SESSION", "code_information": [{"code": "T2036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAMPYLOBACTER ANTIBODY", "code_information": [{"code": "86625", "type": "CPT"}], "standard_charges": [{"minimum": 15.09, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANAKINUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0638", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANAL PREP/FITTING OF DOWEL", "code_information": [{"code": "D3950", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANALITH REPOSITIONING PROC", "code_information": [{"code": "95992", "type": "CPT"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANALITH REPOSITIONING PROCEDURE", "code_information": [{"code": "4000048", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 104.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CANCELLED APPOINTMENT", "code_information": [{"code": "D9987", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANCER STAGE DOCD METAST", "code_information": [{"code": "3301F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANCER TREATMENT PLAN CHANGE", "code_information": [{"code": "S0354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANCER TREATMENTPLAN INITIAL", "code_information": [{"code": "S0353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANDIDA ANTIBODY", "code_information": [{"code": "86628", "type": "CPT"}], "standard_charges": [{"minimum": 13.81, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA AMP PROBE", "code_information": [{"code": "87481", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 40.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA QUANT", "code_information": [{"code": "87482", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 64.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 64.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANDIDA SPECIES PNL AMP PRB", "code_information": [{"code": "68U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANE ADJUSTABLE LUMEN", "code_information": [{"code": "3000100", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CANE QUARD LUMEX", "code_information": [{"code": "3000101", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CANNABINOID SYNTHETIC 7/MORE", "code_information": [{"code": "80352", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS NATURAL", "code_information": [{"code": "80349", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 1-3", "code_information": [{"code": "80350", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 4-6", "code_information": [{"code": "80351", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANNULA DECLOTTING", "code_information": [{"code": "36861", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANNULA LEVER LOCK", "code_information": [{"code": "3000102", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CANNULA SYRINGE", "code_information": [{"code": "3000105", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAP BACTERIAL ASSESS", "code_information": [{"code": "12F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAPSAICIN 8% PATCH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7336", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAPTOPRIL TAB 12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000739", "type": "CDM"}, {"code": "63629289601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR CNV LOC MAP", "code_information": [{"code": "746T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR N-INVAS LOC", "code_information": [{"code": "745T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARRHYT DLVR RAD", "code_information": [{"code": "747T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ACOUS WAVFRM REC CAD RSK", "code_information": [{"code": "716T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNLPTHY GEN SEQ PNL", "code_information": [{"code": "237U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 10 GNS", "code_information": [{"code": "81413", "type": "CPT"}], "standard_charges": [{"minimum": 672.64, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 672.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 2 GNS", "code_information": [{"code": "81414", "type": "CPT"}], "standard_charges": [{"minimum": 672.64, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 672.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR OUTP MEAS DRG CATH CHD", "code_information": [{"code": "93598", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR-CAR BP GRFT/ENDOVAS TAA", "code_information": [{"code": "33891", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARAFATE (SUCRALFATE) 1GM TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000437", "type": "CDM"}, {"code": "60687069501", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARAFATE (SUCRALFATE) LIQ 1GM/10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200038", "type": "CDM"}, {"code": "00254101196", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARAKLENZ 8OZ", "code_information": [{"code": "3000107", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARBATROL ER (CARBAMAZEPINE) CAP 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000778", "type": "CDM"}, {"code": "54092017212", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARBATROL ER (CARBAMAZEPINE) CAP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000602", "type": "CDM"}, {"code": "54092017312", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARBIDOPA LEVODOPA ENT 100ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7340", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARBINOXAMINE MALEATE 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000982", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARBOHYDRATE Ag 19-9", "code_information": [{"code": "86301", "type": "CPT"}, {"code": "1000521", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 23.93, "maximum": 110.86, "gross_charge": 123.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 98.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 110.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 70.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBON MONOXIDE", "code_information": [{"code": "82375", "type": "CPT"}, {"code": "1000016", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.17, "maximum": 65.66, "gross_charge": 72.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 58.36, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 65.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 41.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBOPLATIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARD HRT TRNSPL 96 DNA SEQ", "code_information": [{"code": "55U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARD MRI VELOC FLOW MAPPING", "code_information": [{"code": "75565", "type": "CPT"}], "standard_charges": [{"minimum": 69.69, "maximum": 69.69, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 69.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARD MRI W/STRESS IMG & DYE", "code_information": [{"code": "75563", "type": "CPT"}], "standard_charges": [{"minimum": 652.22, "maximum": 652.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 652.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARD TAMP W/IN 30D", "code_information": [{"code": "G9408", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [{"code": "297", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [{"code": "296", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC", "code_information": [{"code": "298", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [{"code": "309", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [{"code": "308", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "310", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [{"code": "306", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [{"code": "307", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [{"code": "275", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR", "code_information": [{"code": "276", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [{"code": "277", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC DRUG STRESS TEST", "code_information": [{"code": "93024", "type": "CPT"}], "standard_charges": [{"minimum": 534.79, "maximum": 534.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 534.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC EVENT RECORDER", "code_information": [{"code": "E0616", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC MONITOR", "code_information": [{"code": "93041", "type": "CPT"}, {"code": "11600001", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 40.06, "maximum": 84.11, "gross_charge": 70.29, "discounted_cash": 54.17, "estimated_discounted_cash": 70.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 52.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.23, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MONITOR SYS", "code_information": [{"code": "C1833", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH", "code_information": [{"code": "75557", "type": "CPT"}], "standard_charges": [{"minimum": 426.47, "maximum": 426.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 426.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH W/DYE", "code_information": [{"code": "75561", "type": "CPT"}], "standard_charges": [{"minimum": 556.9, "maximum": 556.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 556.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRAIN", "code_information": [{"code": "C9762", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRESS", "code_information": [{"code": "C9763", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI W/STRESS IMG", "code_information": [{"code": "75559", "type": "CPT"}], "standard_charges": [{"minimum": 573.9, "maximum": 573.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 573.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "258", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [{"code": "259", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [{"code": "261", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "260", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "262", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB", "code_information": [{"code": "93797", "type": "CPT"}], "standard_charges": [{"minimum": 478.72, "maximum": 478.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 478.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB/MONITOR", "code_information": [{"code": "93798", "type": "CPT"}], "standard_charges": [{"minimum": 478.72, "maximum": 478.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 478.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHABILITATION PROGR", "code_information": [{"code": "S9472", "type": "HCPCS"}], "standard_charges": [{"minimum": 478.72, "maximum": 478.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 478.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC SHUNT IMAGING", "code_information": [{"code": "78428", "type": "CPT"}], "standard_charges": [{"minimum": 226.15, "maximum": 226.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 226.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [{"code": "217", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "216", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC", "code_information": [{"code": "218", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [{"code": "220", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "219", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC", "code_information": [{"code": "221", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CARDIO CRP", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "1000925", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.89, "maximum": 64.8, "gross_charge": 72.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST EXTERNAL", "code_information": [{"code": "92971", "type": "CPT"}], "standard_charges": [{"minimum": 2061.93, "maximum": 2061.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2061.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST INTERNAL", "code_information": [{"code": "92970", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOKYMOGRAPHY", "code_information": [{"code": "Q0035", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY HRT TRNSPL MRNA", "code_information": [{"code": "81595", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 3726.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3726.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY SS", "code_information": [{"code": "G0063", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOPULM EXERCISE TESTING", "code_information": [{"code": "94621", "type": "CPT"}], "standard_charges": [{"minimum": 326.52, "maximum": 326.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 326.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOPULMONARY RESUSCITATION", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "11000224", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 425.49, "maximum": 2899.78, "gross_charge": 746.49, "discounted_cash": 54.17, "estimated_discounted_cash": 746.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 559.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 597.19, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2899.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 671.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 425.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93015", "type": "CPT"}], "standard_charges": [{"minimum": 534.79, "maximum": 534.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 534.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93016", "type": "CPT"}], "standard_charges": [{"minimum": 534.79, "maximum": 534.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 534.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93017", "type": "CPT"}], "standard_charges": [{"minimum": 534.79, "maximum": 534.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 534.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93018", "type": "CPT"}], "standard_charges": [{"minimum": 534.79, "maximum": 534.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 534.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC INT", "code_information": [{"code": "92961", "type": "CPT"}], "standard_charges": [{"minimum": 2061.93, "maximum": 2061.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2061.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIZEM (DILTIAZEM HCL) 120MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000515", "type": "CDM"}, {"code": "00904721761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDIZEM (DILTIAZEM) 125MG/ 100ML NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "72001078", "type": "CDM"}, {"code": "00641601310", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 30.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIZEM (DILTIAZEM) 25MG/5ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "7000156", "type": "CDM"}, {"code": "00641921910", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 30.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIZEM (DILTIAZEM) 60MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002601", "type": "CDM"}, {"code": "60687072801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDIZEM (DILTIAZEM) TAB 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000157", "type": "CDM"}, {"code": "00093031801", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDIZEM (NF-dilTIAZem HCl) Cap 90MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002847", "type": "CDM"}, {"code": "00093032001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDIZEM ER (DILTIAZEM ER) TAB 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000615", "type": "CDM"}, {"code": "24979002907", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDIZEM ER (DILTIAZEM) CAP 120MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000155", "type": "CDM"}, {"code": "00904721761", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDIZEM ER (DILTIAZEM) CAP 180MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000154", "type": "CDM"}, {"code": "60505001506", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDIZEM ER (DILTIAZEM) TAB 360MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000146", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDIZEM XR(DILTIAZEM) CAP 180MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001036", "type": "CDM"}, {"code": "60505001506", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDURA (DOXAZOSIN MESY) 2MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000466", "type": "CDM"}, {"code": "00904552361", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARDURA Tablet 8MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002457", "type": "CDM"}, {"code": "50268022515", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CARE AFTER DELIVERY", "code_information": [{"code": "59430", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE COORD AT HOSPICE", "code_information": [{"code": "G9477", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE LEVEL RATIONALE DOC", "code_information": [{"code": "6005F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 20 MI", "code_information": [{"code": "G0081", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 30 M", "code_information": [{"code": "G0082", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 45 M", "code_information": [{"code": "G0083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 60 M", "code_information": [{"code": "G0084", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 75 M", "code_information": [{"code": "G0085", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 30 M", "code_information": [{"code": "G0086", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 60 M", "code_information": [{"code": "G0087", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 20 M", "code_information": [{"code": "G0076", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 30 M", "code_information": [{"code": "G0077", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 45 M", "code_information": [{"code": "G0078", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 60 M", "code_information": [{"code": "G0079", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 75 M", "code_information": [{"code": "G0080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAGE BEH SVS 20MINS", "code_information": [{"code": "G0323", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MGMT SVC BHVL HLTH COND", "code_information": [{"code": "99484", "type": "CPT"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE NOT POSS MED RSN", "code_information": [{"code": "M1147", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE OF MISCARRIAGE", "code_information": [{"code": "59820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE PLAN HGB DOCD ESA PT", "code_information": [{"code": "514F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE SURVEY NOT COMPLETE", "code_information": [{"code": "G0917", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARECOORDINATION PRENATAL", "code_information": [{"code": "H1002", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAREGIVER DEM TRAINED", "code_information": [{"code": "G2185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAREGIVER HEALTH RISK ASSMT", "code_information": [{"code": "96161", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAREPATCH PER SQ CM", "code_information": [{"code": "Q4236", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARIES MED APP PER TOOTH", "code_information": [{"code": "D1355", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS HIGH RISK", "code_information": [{"code": "D0603", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS LOW RISK", "code_information": [{"code": "D0601", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS MOD RISK", "code_information": [{"code": "D0602", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARIES SUSCEPTIBILITY TEST", "code_information": [{"code": "D0425", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARMUSTINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARNITINE, TOTAL & FREE", "code_information": [{"code": "82379", "type": "CPT"}, {"code": "1000935", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.4, "maximum": 84.42, "gross_charge": 93.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 75.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 84.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 53.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [{"code": "35", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [{"code": "34", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "36", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CAROTID INTIMA ATHEROMA EVAL", "code_information": [{"code": "93895", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARPAL TUNNEL SURGERY", "code_information": [{"code": "64721", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO +30MIN", "code_information": [{"code": "94781", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO 60 MIN", "code_information": [{"code": "94780", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT", "code_information": [{"code": "T1016", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT, PER MONTH", "code_information": [{"code": "T2022", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MGMT, APPT BARRIERS", "code_information": [{"code": "D9991", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MGMT, CARE COORDINATION", "code_information": [{"code": "D9992", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MGMT, INTERVIEWING", "code_information": [{"code": "D9993", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MGMT, PT EDUCATION", "code_information": [{"code": "D9994", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE PRESENTATION TX PLAN", "code_information": [{"code": "D9450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASODEX (BICALUTAMIDE) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000401", "type": "CDM"}, {"code": "47335048583", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CASPOFUNGIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0637", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAST NOBLE METAL INLAY 2 SUR", "code_information": [{"code": "D6606", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAST PADDING 2", "code_information": [{"code": "3000108", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAST PADDING 3", "code_information": [{"code": "3000109", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAST PADDING 4", "code_information": [{"code": "3000110", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAST PADDING 6", "code_information": [{"code": "3000149", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAST SHOE FEM SM POST OP", "code_information": [{"code": "3000113", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 17.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAST SHOE PEDIATRIC LARGE", "code_information": [{"code": "3000117", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAST SHOE PEDIATRIC SMALL", "code_information": [{"code": "3000118", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAST SUPPLIES (PLASTER)", "code_information": [{"code": "A4580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAST SUPPLIES UNLISTED", "code_information": [{"code": "Q4050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASTING TAPE DELTA-LITE 4", "code_information": [{"code": "3001210", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 37.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CASTOR OIL 59ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000082", "type": "CDM"}, {"code": "00395051592", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAT SCAN FOLLOW-UP STUDY", "code_information": [{"code": "76380", "type": "CPT"}], "standard_charges": [{"minimum": 168.69, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 168.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAT SCRATCH TITER", "code_information": [{"code": "86611", "type": "CPT"}, {"code": "1000286", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.71, "maximum": 96.7, "gross_charge": 60.21, "discounted_cash": 54.17, "estimated_discounted_cash": 60.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATAPRES (CLONIDINE) HCL TAB 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000118", "type": "CDM"}, {"code": "60687011301", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATAPRES (CLONIDINE) HCL TAB 0.2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000119", "type": "CDM"}, {"code": "60687012401", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATAPRES (CLONIDINE) PATCH 0.2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000417", "type": "CDM"}, {"code": "00378087299", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATAPRES-TTS-1 PATCH (CLONIDINE) 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000083", "type": "CDM"}, {"code": "82089010134", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 108.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATARACT SURG W/IOL 1 STAGE", "code_information": [{"code": "66983", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATECHOLAMINES 24HR UR", "code_information": [{"code": "82384", "type": "CPT"}, {"code": "1000144", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 29.04, "maximum": 134.54, "gross_charge": 149.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 119.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 134.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATECHOLAMINES, FRACTIONATED, PLASMA", "code_information": [{"code": "82384", "type": "CPT"}, {"code": "1000624", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 29.04, "maximum": 134.54, "gross_charge": 149.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 119.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 134.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH CENTRAL VENOUS #16", "code_information": [{"code": "3000425", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.88, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH COUDE 12FR", "code_information": [{"code": "3000426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH COUDE 14FR", "code_information": [{"code": "3000427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH COUDE 16FR", "code_information": [{"code": "3000428", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH COUDE 18FR", "code_information": [{"code": "3000429", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH COUDE 20FR", "code_information": [{"code": "3000430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH CVC 8FR KIT ADULT", "code_information": [{"code": "3000432", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH EXT MALE MED", "code_information": [{"code": "3001102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH EXT MALE SM", "code_information": [{"code": "3001103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH EXTERNAL INCONT LG", "code_information": [{"code": "3000433", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY 18 FR W/30CC", "code_information": [{"code": "3000434", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY 20 FR W/30CC", "code_information": [{"code": "3000435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY 22 FR W/30CC", "code_information": [{"code": "3000436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY 24 FR W/30CC", "code_information": [{"code": "3000437", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY 28 FR W/30CC", "code_information": [{"code": "3001384", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY 3 WAY IRRIGATION 16FR", "code_information": [{"code": "3001120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.57, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY 30FR W/30CC", "code_information": [{"code": "3001187", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY FR 10 W/5CC", "code_information": [{"code": "3000438", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY FR 12 RED RUBBER", "code_information": [{"code": "3001456", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY FR 14 W/5CC", "code_information": [{"code": "3000439", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY FR 16 W/5CC", "code_information": [{"code": "3000441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY FR 18 W/5CC", "code_information": [{"code": "3000442", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY FR 28 W/5CC", "code_information": [{"code": "3000443", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY FR 8 RED RUBBER", "code_information": [{"code": "3001457", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY FR 8 W/3CC", "code_information": [{"code": "3000445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY LATX IC 5CC 22FR", "code_information": [{"code": "3001017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH FOLEY LATX IC 5CC 24FR", "code_information": [{"code": "3001020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH IMPL VASC ACCESS PORTAL", "code_information": [{"code": "A4300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH KIT PEDIATRIC", "code_information": [{"code": "3001386", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH KIT UROSTOMY 2 WAY FIG LEAF 16FR", "code_information": [{"code": "3001366", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH LEG STRAP", "code_information": [{"code": "3001025", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH PLACE CARDIO BRACHYTX", "code_information": [{"code": "92974", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH PLUG & TIP", "code_information": [{"code": "3000454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILASTIC 28 FR", "code_information": [{"code": "3000456", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICON 14FR W/10ML", "code_information": [{"code": "3000457", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICONE 16 FR", "code_information": [{"code": "3000458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICONE 18 FR", "code_information": [{"code": "3000459", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICONE 18FR W", "code_information": [{"code": "3000460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICONE 20 FR", "code_information": [{"code": "3000461", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICONE 20FR W", "code_information": [{"code": "3000462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICONE 22 FR", "code_information": [{"code": "3000464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICONE 24 FR", "code_information": [{"code": "3000466", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SILICONE 24 FR/30CC", "code_information": [{"code": "3000465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SUCT 12 FR", "code_information": [{"code": "3001337", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SUCTION 10FR TUBE", "code_information": [{"code": "3000467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SUCTION 14FR TUBE", "code_information": [{"code": "3000470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH SUCTION 8FR TUBE", "code_information": [{"code": "3000469", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH THORACIC 10 FR", "code_information": [{"code": "3001172", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 42.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH THORACIC 16 FR", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "3000589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 9.4, "maximum": 14.85, "gross_charge": 16.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH THORACIC 20 FR", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "3000472", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 8.89, "maximum": 14.04, "gross_charge": 15.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH THORACIC 24 FR", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "3000473", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 5.7, "maximum": 9.0, "gross_charge": 10.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH THORACIC 28 FR", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "3000474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 12.02, "maximum": 18.99, "gross_charge": 21.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH THORACIC 32 FR", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "3001304", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 12.02, "maximum": 18.99, "gross_charge": 21.1, "discounted_cash": 54.17, "estimated_discounted_cash": 3.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH THORACIC 36 FR", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "3000475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 12.02, "maximum": 18.99, "gross_charge": 21.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH THORACIC 40 FR", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "3001173", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 8.89, "maximum": 14.04, "gross_charge": 15.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH THORACIC 8 FR", "code_information": [{"code": "3001171", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 42.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH TRAY INTERMITTENT 14 FR", "code_information": [{"code": "3000476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATH, BAL DIL, NON-VASCULAR", "code_information": [{"code": "C1726", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, BAL TIS DIS, NON-VAS", "code_information": [{"code": "C1727", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, BLADED, VASC PREP", "code_information": [{"code": "C1600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, BRACHYTX SEED ADM", "code_information": [{"code": "C1728", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, EP, 19 OR FEW ELECT", "code_information": [{"code": "C1730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, EP, 20 OR MORE ELEC", "code_information": [{"code": "C1731", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, EP, COOL-TIP", "code_information": [{"code": "C2630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, EP, DIAG/ABL, 3D/VECT", "code_information": [{"code": "C1732", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, EP, OTHR THAN COOL-TIP", "code_information": [{"code": "C1733", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, HEMODIALYSIS,LONG-TERM", "code_information": [{"code": "C1750", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, INF, PER/CENT/MIDLINE", "code_information": [{"code": "C1751", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, INTRA ECHOCARDIOGRAPHY", "code_information": [{"code": "C1759", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, INTRAVAS ULTRASOUND", "code_information": [{"code": "C1753", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, PACING, TRANSESOPH", "code_information": [{"code": "C1756", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, PRESSURE,VALVE-OCCLU", "code_information": [{"code": "C1982", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, SUPRAPUBIC/CYSTOSCOPIC", "code_information": [{"code": "C2627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, THROMBECTOMY/EMBOLECT", "code_information": [{"code": "C1757", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, TRANS ATHEREC,ROTATION", "code_information": [{"code": "C1724", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, TRANS ATHERECTOMY, DIR", "code_information": [{"code": "C1714", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, TRANS INTRA LITHO/CORO", "code_information": [{"code": "C1761", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, TRANSLUMIN ANGIO LASER", "code_information": [{"code": "C1885", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, TRANSLUMIN NON-LASER", "code_information": [{"code": "C1725", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, TRANSLUMIN, DRUG-COAT", "code_information": [{"code": "C2623", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH,HEMODIALYSIS,SHORT-TERM", "code_information": [{"code": "C1752", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/EMBOL", "code_information": [{"code": "C7515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/STENTS", "code_information": [{"code": "C7514", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIALCIR W/APLASTY", "code_information": [{"code": "C7513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH/APLASTY DIAL CIR W/STNT", "code_information": [{"code": "C7530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER FOR HYSTEROGRAPHY", "code_information": [{"code": "58340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER STABILIZATION DEVICE", "code_information": [{"code": "3001345", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CATHETER, ABLATION", "code_information": [{"code": "C1886", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER, GUIDING", "code_information": [{"code": "C1887", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER, INTRADISCAL", "code_information": [{"code": "C1754", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER, INTRASPINAL", "code_information": [{"code": "C1755", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER, OCCLUSION", "code_information": [{"code": "C2628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER, URETERAL", "code_information": [{"code": "C1758", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETERIZE FOR URINE SPEC", "code_information": [{"code": "P9612", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHFLO ACTIVASE 2MG INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}, {"code": "72000890", "type": "CDM"}, {"code": "50242004164", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 114.0, "maximum": 267.21, "gross_charge": 200.0, "discounted_cash": 54.17, "estimated_discounted_cash": 12811.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAUTERIZATION OF CERVIX", "code_information": [{"code": "57510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAUTERY (DISP)", "code_information": [{"code": "3000478", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CAVOPULMONARY SHUNTING", "code_information": [{"code": "33768", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CBC NO DIFF", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "1000959", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.44, "maximum": 32.4, "gross_charge": 36.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC W/ AUTODIFF-CHARGE ONLY", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "1000177", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.94, "maximum": 40.5, "gross_charge": 45.0, "discounted_cash": 54.17, "estimated_discounted_cash": 46.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC W/ MANUAL DIFF-CHARGE ONLY", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "1000093", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.94, "maximum": 40.5, "gross_charge": 45.0, "discounted_cash": 54.17, "estimated_discounted_cash": 46.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC WITHOUT PLATELET", "code_information": [{"code": "G0307", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CBC/DIFFWBC W/O PLATELET", "code_information": [{"code": "G0306", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CBT 1ST HOUR", "code_information": [{"code": "94644", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CBT EACH ADDL HOUR", "code_information": [{"code": "94645", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CCIIV3 VAC NO PRSV 0.5 ML IM", "code_information": [{"code": "90661", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CCIIV4 VAC NO PRSV 0.5 ML IM", "code_information": [{"code": "90674", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CCIIV4 VACC ABX FREE IM", "code_information": [{"code": "90756", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CCM/BHI BY RHC/FQHC 20MIN MO", "code_information": [{"code": "G0511", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CCND1/IGH TRANSLOCATION ALYS", "code_information": [{"code": "81168", "type": "CPT"}], "standard_charges": [{"minimum": 238.41, "maximum": 238.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CCP ANTIBODY", "code_information": [{"code": "86200", "type": "CPT"}], "standard_charges": [{"minimum": 14.89, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CD4", "code_information": [{"code": "86361", "type": "CPT"}, {"code": "1000858", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 30.8, "maximum": 137.7, "gross_charge": 153.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 87.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CD4+ CELL >=15% (HIV)", "code_information": [{"code": "3498F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CD4+ CELL COUNT >= 500 CELLS", "code_information": [{"code": "3496F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CD4+ CELL PERCENTAGE <15%", "code_information": [{"code": "3497F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CD4+CELL CNT 200-499 CELLS", "code_information": [{"code": "3495F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CD4+CELL CNT/% DOCD AS DONE", "code_information": [{"code": "3500F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CD4+CELL COUNT <200CELLS/MM3", "code_information": [{"code": "3494F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CD4: CD8 RATIO PROFILE", "code_information": [{"code": "86360", "type": "CPT"}, {"code": "1000727", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 54.03, "maximum": 250.29, "gross_charge": 278.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 222.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 250.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 158.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CDIFFICILE TESTING PERFORMED", "code_information": [{"code": "3520F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CDP-SOT 6 COND W/I&R", "code_information": [{"code": "92548", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CDP-SOT 6 COND W/I&R MCT&ADT", "code_information": [{"code": "92549", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CDTB&VINCULIN IGG ANTB IA", "code_information": [{"code": "176U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEA", "code_information": [{"code": "82378", "type": "CPT"}, {"code": "1000060", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.8, "maximum": 101.06, "gross_charge": 112.29, "discounted_cash": 54.17, "estimated_discounted_cash": 112.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 89.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEBPA GENE FULL SEQUENCE", "code_information": [{"code": "81218", "type": "CPT"}], "standard_charges": [{"minimum": 278.19, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 278.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEFEPIME 2GM VIAL/0.9% NS 100ML", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J0692", "type": "HCPCS"}, {"code": "72001118", "type": "CDM"}, {"code": "00409973510", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.19, "maximum": 12.93, "gross_charge": 14.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 11.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 12.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFOTAXIME SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0698", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEFOXITIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0694", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEFTAZIDIME/AVIBACTAM 2-0.5GM VIAL", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J0714", "type": "HCPCS"}, {"code": "72004331", "type": "CDM"}, {"code": "00456270010", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 658.42, "maximum": 1039.62, "gross_charge": 1155.14, "discounted_cash": 54.17, "estimated_discounted_cash": 38.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 866.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 924.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1039.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 658.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFTIN (CEFUROXIME) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000086", "type": "CDM"}, {"code": "65862069960", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CEFTIN SUSP 125MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000577", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 167.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CEFTIZOXIME SODIUM / 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0715", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEFZIL (CEFPROZIL) 125MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000088", "type": "CDM"}, {"code": "00781620291", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 36.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CEFZIL (CEFPROZIL) 500MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001110", "type": "CDM"}, {"code": "57237003750", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CEFZIL (CEFPROZIL) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000091", "type": "CDM"}, {"code": "65862069960", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CELEBREX (CELECOXIB) CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000092", "type": "CDM"}, {"code": "69097042207", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CELEBREX 50MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001066", "type": "CDM"}, {"code": "69097042303", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CELERA PER SQ CM", "code_information": [{"code": "Q4259", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELEXA (CITALOPRAM HYDROBRO) 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000179", "type": "CDM"}, {"code": "00904608561", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CELIAC DISEASE PROFILE", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000243", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELIAC PROFILE II W/IgG", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000596", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL BLOCK", "code_information": [{"code": "88104", "type": "CPT"}, {"code": "1200003", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 30.71, "maximum": 85.86, "gross_charge": 95.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 72.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 76.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 85.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 54.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL COUNT BODY FLUID", "code_information": [{"code": "89051", "type": "CPT"}, {"code": "1000642", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.44, "maximum": 30.71, "gross_charge": 32.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 26.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 29.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL COUNT&CRYSTALS SYNOVIAL FLUID", "code_information": [{"code": "89050", "type": "CPT"}, {"code": "1000221", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.43, "maximum": 30.71, "gross_charge": 27.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 22.39, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 15.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL CRYOPRESERVE/STORAGE", "code_information": [{"code": "88240", "type": "CPT"}], "standard_charges": [{"minimum": 15.03, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELL ENUMERATION & ID", "code_information": [{"code": "86152", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 288.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 288.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELL ENUMERATION PHYS INTERP", "code_information": [{"code": "86153", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 104.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 104.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELL FUNCTION ASSAY W/STIM", "code_information": [{"code": "86352", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 156.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 156.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELL MARKER STUDY", "code_information": [{"code": "88182", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 155.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 155.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELLCEPT (MYCOPHENOLATE) 200MG/ML SUSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7517", "type": "HCPCS"}, {"code": "7004355", "type": "CDM"}, {"code": "00527516082", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.73, "maximum": 9.05, "gross_charge": 10.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 5.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELLESTA CORD PER SQ CM", "code_information": [{"code": "Q4214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELLESTA FLOWAB AMNION 0.5CC", "code_information": [{"code": "Q4185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELLESTA OR DUO PER SQ CM", "code_information": [{"code": "Q4184", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELLULAR THERAPY", "code_information": [{"code": "M0075", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CELLULITIS WITH MCC", "code_information": [{"code": "602", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CELLULITIS WITHOUT MCC", "code_information": [{"code": "603", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 4330.4, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CENTERBASED DAY CARE PERDIEM", "code_information": [{"code": "S5105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CENTRAL DEXA ORDERED", "code_information": [{"code": "3096F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CENTRAL DEXA RESULTS DOCD", "code_information": [{"code": "3095F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CENTRAL VENOUS CATH TRAY TRIPLE LUMEN", "code_information": [{"code": "3001141", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CENTRIFUGE", "code_information": [{"code": "E1500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CENTRUM SILVER (MULTIVIT/FE/MIN) TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000099", "type": "CDM"}, {"code": "00005446391", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CENTRUROIDES IMMUNE F(AB)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0716", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEP72 NUDT15&TPMT GENE ALYS", "code_information": [{"code": "286U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEPHALIN FLOCULATION TEST", "code_information": [{"code": "P2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.73, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEPHAPIRIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEREBROSPINAL FLUID SCAN", "code_information": [{"code": "78630", "type": "CPT"}], "standard_charges": [{"minimum": 400.72, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 400.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEREBYX (FOSPHENY) 50mgPE/ML IM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "Q2009", "type": "HCPCS"}, {"code": "72000528", "type": "CDM"}, {"code": "00069600125", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEREBYX 500mgPE/10ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "Q2009", "type": "HCPCS"}, {"code": "7000098", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERT NURSE MIDWIFE SS", "code_information": [{"code": "G0064", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CERTOLIZUMAB PEGOL INJ 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0717", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CERULOPLASMIN", "code_information": [{"code": "82390", "type": "CPT"}, {"code": "1000672", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.35, "maximum": 57.21, "gross_charge": 63.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV CANCER SCREEN DOCD", "code_information": [{"code": "3015F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CERVICAL CAP CONTRACEPTIVE", "code_information": [{"code": "A4261", "type": "HCPCS"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CERVICAL LAMINOPLSTY 2/> SEG", "code_information": [{"code": "63050", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [{"code": "472", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "471", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "473", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CESAREAN BIRTH CLASS", "code_information": [{"code": "S9438", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59515", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY ONLY", "code_information": [{"code": "59514", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [{"code": "784", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [{"code": "783", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "785", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [{"code": "787", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [{"code": "786", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "788", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CESSJ THERAPY CATH REMOVAL", "code_information": [{"code": "37214", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CETUXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9055", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CFTR GENE COM VARIANTS", "code_information": [{"code": "81220", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 640.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 640.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CFTR GENE DUP/DELET VARIANTS", "code_information": [{"code": "81222", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 500.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 500.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CFTR GENE FULL SEQUENCE", "code_information": [{"code": "81223", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 573.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 573.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CFTR GENE INTRON POLY T", "code_information": [{"code": "81224", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 194.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 194.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CFTR GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81221", "type": "CPT"}], "standard_charges": [{"minimum": 111.8, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 111.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CGH TEST DEVELOPMENTAL DELAY", "code_information": [{"code": "S3870", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CGS DOSE ADJ INSULIN INF PMP", "code_information": [{"code": "E0787", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHAMOSYN OINTMENT", "code_information": [{"code": "3001478", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHANGE G-TUBE TO G-J PERC", "code_information": [{"code": "49446", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHANGE GASTRIC PORT OPEN", "code_information": [{"code": "43888", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHANGE NEPHROURETERAL CATH", "code_information": [{"code": "50387", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51705", "type": "CPT"}], "standard_charges": [{"minimum": 637.4, "maximum": 637.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 637.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51710", "type": "CPT"}], "standard_charges": [{"minimum": 637.4, "maximum": 637.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 637.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHANGE OF URETER TUBE/STENT", "code_information": [{"code": "50688", "type": "CPT"}], "standard_charges": [{"minimum": 637.4, "maximum": 637.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 637.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHANGE OF WINDPIPE AIRWAY", "code_information": [{"code": "31502", "type": "CPT"}], "standard_charges": [{"minimum": 637.4, "maximum": 637.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 637.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHANGE STENT VIA TRANSURETH", "code_information": [{"code": "50385", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERCUT", "code_information": [{"code": "50382", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHAP SERVICES AT HOSPICE", "code_information": [{"code": "G9473", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHAPLAIN ASSESSMENT", "code_information": [{"code": "Q9001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHAPLAIN COUNSEL GROUP", "code_information": [{"code": "Q9003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHAPLAIN COUNSEL INDIVIDU", "code_information": [{"code": "Q9002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHCT FOR MAL HYPERTHERMIA", "code_information": [{"code": "89049", "type": "CPT"}], "standard_charges": [{"minimum": 68.95, "maximum": 68.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 68.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEM/ANTISEPT SOLUTION, 8OZ", "code_information": [{"code": "A4674", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMICAL CAUTERIZATION", "code_information": [{"code": "17250", "type": "CPT"}, {"code": "11000289", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.99, "maximum": 456.3, "gross_charge": 507.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE DERMAL", "code_information": [{"code": "15789", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE EPIDERM", "code_information": [{"code": "15788", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15792", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15793", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASSAY", "code_information": [{"code": "82397", "type": "CPT"}], "standard_charges": [{"minimum": 16.24, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO ANTI-NEOPL SQ/IM", "code_information": [{"code": "96401", "type": "CPT"}], "standard_charges": [{"minimum": 94.52, "maximum": 94.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 94.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO BY BOTH INFUSION AND O", "code_information": [{"code": "Q0085", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.98, "maximum": 966.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO BY OTHER THAN INFUSION", "code_information": [{"code": "Q0083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO EXTEND IV INFUS W/PUMP", "code_information": [{"code": "G0498", "type": "HCPCS"}], "standard_charges": [{"minimum": 1636.8, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO HORMON ANTINEOPL SQ/IM", "code_information": [{"code": "96402", "type": "CPT"}], "standard_charges": [{"minimum": 41.68, "maximum": 41.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSE EACH ADDL HR", "code_information": [{"code": "96423", "type": "CPT"}], "standard_charges": [{"minimum": 94.31, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 94.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSION UP TO 1 HR", "code_information": [{"code": "96422", "type": "CPT"}], "standard_charges": [{"minimum": 203.08, "maximum": 966.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 203.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO IA PUSH TECNIQUE", "code_information": [{"code": "96420", "type": "CPT"}], "standard_charges": [{"minimum": 133.77, "maximum": 133.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 133.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL OVER 7", "code_information": [{"code": "96406", "type": "CPT"}], "standard_charges": [{"minimum": 58.64, "maximum": 58.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL UP TO 7", "code_information": [{"code": "96405", "type": "CPT"}], "standard_charges": [{"minimum": 37.63, "maximum": 37.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 37.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUS EACH ADDL SEQ", "code_information": [{"code": "96417", "type": "CPT"}], "standard_charges": [{"minimum": 82.89, "maximum": 966.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 82.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION ADDL HR", "code_information": [{"code": "96415", "type": "CPT"}], "standard_charges": [{"minimum": 36.7, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH ADDL DRUG", "code_information": [{"code": "96411", "type": "CPT"}], "standard_charges": [{"minimum": 71.63, "maximum": 71.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 71.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH SNGL DRUG", "code_information": [{"code": "96409", "type": "CPT"}], "standard_charges": [{"minimum": 130.82, "maximum": 130.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMO PROLONG INFUSE W/PUMP", "code_information": [{"code": "96416", "type": "CPT"}], "standard_charges": [{"minimum": 165.92, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 165.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENER MUSCLE LARYNX EMG", "code_information": [{"code": "64617", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 1-4 EA", "code_information": [{"code": "64643", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> EA", "code_information": [{"code": "64645", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> MUS", "code_information": [{"code": "64644", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREMITY 1-4", "code_information": [{"code": "64642", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ADDUCT VOCAL", "code_information": [{"code": "S2341", "type": "HCPCS"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64650", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64653", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC MIGRAINE", "code_information": [{"code": "64615", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC NECK DYSTON", "code_information": [{"code": "64616", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV SALIV GLANDS", "code_information": [{"code": "64611", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 1-5", "code_information": [{"code": "64646", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 6/>", "code_information": [{"code": "64647", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION ANAL MUSC", "code_information": [{"code": "46505", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ABDUCTOR", "code_information": [{"code": "S2340", "type": "HCPCS"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTAXIS ASSAY", "code_information": [{"code": "86155", "type": "CPT"}], "standard_charges": [{"minimum": 18.39, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY BY INFUSION", "code_information": [{"code": "Q0084", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.98, "maximum": 966.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY DRUG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INFUSION METHOD", "code_information": [{"code": "96425", "type": "CPT"}], "standard_charges": [{"minimum": 218.45, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 218.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INJECTION", "code_information": [{"code": "96542", "type": "CPT"}], "standard_charges": [{"minimum": 55.47, "maximum": 55.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INTO CNS", "code_information": [{"code": "96450", "type": "CPT"}], "standard_charges": [{"minimum": 101.12, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 101.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [{"code": "837", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [{"code": "838", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "839", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [{"code": "847", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [{"code": "846", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "848", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHEMOTX ADMN PERTL CAV IMPL", "code_information": [{"code": "96446", "type": "CPT"}], "standard_charges": [{"minimum": 35.03, "maximum": 966.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 35.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEST PAIN", "code_information": [{"code": "313", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHEST SHELL", "code_information": [{"code": "E0457", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEST WALL MANIPULATION", "code_information": [{"code": "94667", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEST WALL MANIPULATION", "code_information": [{"code": "94668", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEST WRAP", "code_information": [{"code": "E0459", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHGE URTR STENT W/ DIL STRIC", "code_information": [{"code": "C7549", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHIKUNGUNYA VACCINE LIVE IM", "code_information": [{"code": "90589", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHILD FOSTERCARE TH PER DIEM", "code_information": [{"code": "S5145", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHILD SITTING SERVICES", "code_information": [{"code": "T1009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHILDBIRTH REFRESHER CLASS", "code_information": [{"code": "S9437", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHILDREN'S FEVER REDUCER RECTAL SUPP 120", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "800", "type": "CDM"}, {"code": "45802073230", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [{"code": "18", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHIMERISM ANAL NO CELL SELEC", "code_information": [{"code": "81267", "type": "CPT"}], "standard_charges": [{"minimum": 238.58, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHIMERISM ANAL W/CELL SELECT", "code_information": [{"code": "81268", "type": "CPT"}], "standard_charges": [{"minimum": 299.91, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 299.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ 1-2 REGIONS", "code_information": [{"code": "98940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ 3-4 REGIONS", "code_information": [{"code": "98941", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ XTRSPINL 1/>", "code_information": [{"code": "98943", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHIROPRACTIC MANJ 5 REGIONS", "code_information": [{"code": "98942", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHIROPRACTIC SS", "code_information": [{"code": "G0065", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA ANTIBODY", "code_information": [{"code": "86631", "type": "CPT"}], "standard_charges": [{"minimum": 13.59, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA IGM ANTIBODY", "code_information": [{"code": "86632", "type": "CPT"}], "standard_charges": [{"minimum": 14.58, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA TRACHOMATIS AG IF", "code_information": [{"code": "87270", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA TRACHOMATIS CULTURE", "code_information": [{"code": "87110", "type": "CPT"}, {"code": "1000941", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 22.54, "maximum": 98.25, "gross_charge": 109.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.33, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA TRACHOMITIS NAA", "code_information": [{"code": "87491", "type": "CPT"}, {"code": "1000918", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 33.38, "maximum": 186.97, "gross_charge": 207.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 166.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 186.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 118.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA/GC, TRICH NAA AMPLIFICATION", "code_information": [{"code": "87801", "type": "CPT"}, {"code": "1000989", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 23.08, "maximum": 351.32, "gross_charge": 390.36, "discounted_cash": 54.17, "estimated_discounted_cash": 390.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 80.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 312.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 351.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 222.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA AMP PROBE", "code_information": [{"code": "87486", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA DIR PROBE", "code_information": [{"code": "87485", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA QUANT", "code_information": [{"code": "87487", "type": "CPT"}], "standard_charges": [{"minimum": 49.27, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH AG IA", "code_information": [{"code": "87320", "type": "CPT"}], "standard_charges": [{"minimum": 17.25, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH ASSAY W/OPTIC", "code_information": [{"code": "87810", "type": "CPT"}], "standard_charges": [{"minimum": 23.08, "maximum": 40.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH DNA DIR PROBE", "code_information": [{"code": "87490", "type": "CPT"}], "standard_charges": [{"minimum": 26.16, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH DNA QUANT", "code_information": [{"code": "87492", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 61.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 61.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLMYD/GONRH TSTS DOCD DONE", "code_information": [{"code": "3511F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLOR-TRIMETON (NF-CHLORPHENIRAMINE) 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001009", "type": "CDM"}, {"code": "50090276506", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHLORAMBUCIL 2 MG", "code_information": [{"code": "S0172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLORAMPHENICOL SODIUM INJEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0720", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLORAPREP AMPULE", "code_information": [{"code": "3001340", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.94, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHLORASEPTIC SPRAY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000954", "type": "CDM"}, {"code": "78112001103", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 20.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHLORDIAZEPOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1990", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLORDIAZEPOXIDE/CLIDINIUM CAP 5MG/2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000121", "type": "CDM"}, {"code": "00187410010", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 11.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHLORHEXIDINE ANTISEPT", "code_information": [{"code": "A4248", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLORHEXIDINE GLUCONATE MM SOLN 0.12%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004316", "type": "CDM"}, {"code": "00116200116", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHLORIDE 24HR URINE", "code_information": [{"code": "82436", "type": "CPT"}, {"code": "1000097", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.61, "maximum": 26.78, "gross_charge": 29.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLORIDE SERUM", "code_information": [{"code": "82435", "type": "CPT"}, {"code": "1000145", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.29, "maximum": 24.46, "gross_charge": 27.18, "discounted_cash": 54.17, "estimated_discounted_cash": 27.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 24.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLORIDE URINE RDM", "code_information": [{"code": "82436", "type": "CPT"}, {"code": "1000657", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.61, "maximum": 26.78, "gross_charge": 29.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLOROPROCAINE (CLOROTEKAL)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLOROPROCAINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2401", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLOROPROCAINE OPHT GEL, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2403", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLOROQUINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLOROTHIAZIDE SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1205", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLORPROMAZINE HCL 50MG/ 2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3230", "type": "HCPCS"}, {"code": "72000055", "type": "CDM"}, {"code": "00641139735", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 19.57, "maximum": 30.91, "gross_charge": 34.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 30.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLORPROMAZINE HCL 5MG ORAL", "code_information": [{"code": "Q0161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHMOTX ADMN PLRL CAV THRCNTS", "code_information": [{"code": "96440", "type": "CPT"}], "standard_charges": [{"minimum": 172.66, "maximum": 172.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 172.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [{"code": "415", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "414", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "416", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [{"code": "412", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [{"code": "411", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "413", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHOLERA VACCINE LIVE ORAL", "code_information": [{"code": "90625", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHOLESTEROL", "code_information": [{"code": "82465", "type": "CPT"}, {"code": "1000147", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.0, "maximum": 23.19, "gross_charge": 25.77, "discounted_cash": 54.17, "estimated_discounted_cash": 25.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 23.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLESTYRAMINE PASTE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001098", "type": "CDM"}, {"code": "49884046566", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHOLINE C-11", "code_information": [{"code": "A9515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHOLINESTERASE (SERUM)", "code_information": [{"code": "82480", "type": "CPT"}, {"code": "1000063", "type": "CDM"}, {"code": "309", "type": "RC"}], "standard_charges": [{"minimum": 9.05, "maximum": 41.98, "gross_charge": 46.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 37.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLINESTERASE CHALLENGE", "code_information": [{"code": "95857", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHOLINESTERASE RBC", "code_information": [{"code": "82482", "type": "CPT"}, {"code": "1000639", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.28, "maximum": 40.93, "gross_charge": 45.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 36.38, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 40.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 25.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHORE SERVICES PER 15 MIN", "code_information": [{"code": "S5120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHORE SERVICES PER DIEM", "code_information": [{"code": "S5121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHORION BIOPSY", "code_information": [{"code": "59015", "type": "CPT"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHORIONIC GONADOTROPIN/1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0725", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRISTIAN SCI NURSE VISIT", "code_information": [{"code": "S9901", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRISTIAN SCI PRACT VISIT", "code_information": [{"code": "S9900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99491", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99437", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT STAF EA ADDL", "code_information": [{"code": "99439", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT STAFF 1ST 20", "code_information": [{"code": "99490", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMAGEN CAPSULES", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000127", "type": "CDM"}, {"code": "51991054390", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CHROMATOGRAM ASSAY SUGARS", "code_information": [{"code": "84375", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 44.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMIUM", "code_information": [{"code": "82495", "type": "CPT"}, {"code": "1000847", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 23.32, "maximum": 106.2, "gross_charge": 118.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 106.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 67.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOGENIC SUBSTRATE ASSAY", "code_information": [{"code": "85130", "type": "CPT"}], "standard_charges": [{"minimum": 13.67, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYS AMNIOTIC", "code_information": [{"code": "88269", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 199.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 199.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYS PLACENTA", "code_information": [{"code": "88267", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 216.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 216.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 100", "code_information": [{"code": "88249", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 199.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 199.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 15-20", "code_information": [{"code": "88262", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 144.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 144.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 20-25", "code_information": [{"code": "88245", "type": "CPT"}], "standard_charges": [{"minimum": 199.15, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 199.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 20-25", "code_information": [{"code": "88264", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 166.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 166.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 45", "code_information": [{"code": "88263", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 172.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 172.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 5", "code_information": [{"code": "88261", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 303.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 303.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 50-100", "code_information": [{"code": "88248", "type": "CPT"}], "standard_charges": [{"minimum": 199.15, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 199.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME BANDING STUDY", "code_information": [{"code": "88283", "type": "CPT"}], "standard_charges": [{"minimum": 78.89, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME COUNT ADDITIONAL", "code_information": [{"code": "88285", "type": "CPT"}], "standard_charges": [{"minimum": 30.95, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME KARYOTYPE STUDY", "code_information": [{"code": "88280", "type": "CPT"}], "standard_charges": [{"minimum": 38.49, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME STUDY ADDITIONAL", "code_information": [{"code": "88289", "type": "CPT"}], "standard_charges": [{"minimum": 39.59, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [{"code": "191", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 2578.55, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [{"code": "190", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 10031.92, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC", "code_information": [{"code": "192", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 5683.75, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CHRONIC PAIN MGMT 30 MINS", "code_information": [{"code": "G3002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRONIC PAIN MGMT ADDL 15M", "code_information": [{"code": "G3003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CIDOFOVIR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0740", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CILIARY TRANSSLERAL THERAPY", "code_information": [{"code": "66710", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CILTACABTAGENE CAR-POS T", "code_information": [{"code": "Q2056", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CINACALCET HCL 30MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0604", "type": "HCPCS"}, {"code": "7003865", "type": "CDM"}, {"code": "64380088304", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 267.21, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS", "code_information": [{"code": "76120", "type": "CPT"}], "standard_charges": [{"minimum": 146.44, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 146.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS ADD-ON", "code_information": [{"code": "76125", "type": "CPT"}], "standard_charges": [{"minimum": 52.52, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 52.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CIPRO (CIPROFLOXACIN) 400MG IVPB PREMIXE", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0744", "type": "HCPCS"}, {"code": "7200102", "type": "CDM"}, {"code": "00409330024", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 30.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIPRO (CIPROFLOXACIN) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000106", "type": "CDM"}, {"code": "60687086001", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CIPRO (NF-Cipro) 250MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002562", "type": "CDM"}, {"code": "00143992701", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN 0.3% OPTH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000109", "type": "CDM"}, {"code": "69315030805", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN DROP 0.3% : 15ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000110", "type": "CDM"}, {"code": "60505100001", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN OTIC SUSP 6 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "286", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "287", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CIRCUM 28 DAYS OR OLDER", "code_information": [{"code": "54161", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION NEONATE", "code_information": [{"code": "54160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION W/REGIONL BLOCK", "code_information": [{"code": "54150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "433", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "432", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "434", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CISPLATIN 10 MG INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CITRACAL PETITES ORAL TABLET 400MG-500IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001133", "type": "CDM"}, {"code": "16500053503", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CITRATE-24 HOUR URINE", "code_information": [{"code": "82507", "type": "CPT"}, {"code": "1000522", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 31.97, "maximum": 148.12, "gross_charge": 164.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 131.66, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 148.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 93.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CKMB2", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "1000239", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.28, "maximum": 61.5, "gross_charge": 68.34, "discounted_cash": 54.17, "estimated_discounted_cash": 68.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.67, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CL MULT VSD W/REM PUL BAND", "code_information": [{"code": "33677", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CL, HYDROPHILIC, DUAL FOCUS", "code_information": [{"code": "V2525", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLAMP FOR POUCH", "code_information": [{"code": "3001245", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLAMP NECK ARTERY", "code_information": [{"code": "61703", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLARITIN (LORATADINE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000114", "type": "CDM"}, {"code": "68084024801", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLARITIN CHILDREN'S ORAL SOLN 5MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001132", "type": "CDM"}, {"code": "00904676720", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLEAN & INSPECT REM DENT MAN", "code_information": [{"code": "D9933", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEAN & INSPECT REM DENT MAX", "code_information": [{"code": "D9932", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69222", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEAN REM PART DENTURE MAND", "code_information": [{"code": "D9935", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEAN REM PART DENTURE MAX", "code_information": [{"code": "D9934", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEAR EYELID GLAND W/HEAT", "code_information": [{"code": "207T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69205", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31725", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF TEAR DUCT", "code_information": [{"code": "68530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEOCIN (CLINDAMYCIN PHOS) 300MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001105", "type": "CDM"}, {"code": "67457081402", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 3.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLEOCIN (CLINDAMYCIN PHOS) 600MG INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "72000527", "type": "CDM"}, {"code": "00009407304", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLIN IND IMG HD TRAUMA", "code_information": [{"code": "G2187", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLIN NODE STGNG DOCDB/4 SURG", "code_information": [{"code": "3323F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLIN PT NO REF", "code_information": [{"code": "G0038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLIN SIG DEP SYM BY DEP TOOL", "code_information": [{"code": "3354F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLIN SIGN VOL OVRLD ASSESS", "code_information": [{"code": "2002F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLIN SYMP VOL OVRLD ASSESS", "code_information": [{"code": "1004F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN (NF-Clindamycin) 75MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002799", "type": "CDM"}, {"code": "59762001601", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 600MG/100ML NS IV", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0736", "type": "HCPCS"}, {"code": "7200108", "type": "CDM"}, {"code": "00009407304", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.81, "maximum": 9.18, "gross_charge": 10.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 8.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 9.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 600MG/50ML D5W IVPB", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0737", "type": "HCPCS"}, {"code": "72001122", "type": "CDM"}, {"code": "00338361224", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 10.29, "maximum": 16.25, "gross_charge": 18.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 14.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN HCL CAP 150MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000116", "type": "CDM"}, {"code": "00904595961", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN PHOS 300MG/100ML NS IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0736", "type": "HCPCS"}, {"code": "72001106", "type": "CDM"}, {"code": "67457081402", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINIC SERVICE", "code_information": [{"code": "T1015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLINICAL SOCIAL WORK SS", "code_information": [{"code": "G0066", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLIPPERS LARGE TOENAIL", "code_information": [{"code": "3000045", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLIPPERS SMALL FINGERNAIL", "code_information": [{"code": "3000026", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CLOFARABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9027", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLONIDINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0735", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSD RDUCTN SPLINT ALVEOLUS", "code_information": [{"code": "D7670", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE BLADDER-UTERUS FISTULA", "code_information": [{"code": "51920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE BRONCHIAL FISTULA", "code_information": [{"code": "32815", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE CHEST AFTER DRAINAGE", "code_information": [{"code": "32810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE KIDNEY-SKIN FISTULA", "code_information": [{"code": "50520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE MASTOID FISTULA", "code_information": [{"code": "69700", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD", "code_information": [{"code": "33675", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD W/RESECTION", "code_information": [{"code": "33676", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50525", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50526", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68761", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR SYSTEM FISTULA", "code_information": [{"code": "68770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSED TMP MANIPULATION", "code_information": [{"code": "D7820", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSED TREAT DISTAL FIBULAR FX LATERAL", "code_information": [{"code": "27788", "type": "CPT"}, {"code": "11000307", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 637.77, "maximum": 1007.01, "gross_charge": 1118.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 839.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 895.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1007.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 637.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREAT DISTAL PHAL FRACT, FING/THU", "code_information": [{"code": "26755", "type": "CPT"}, {"code": "11000296", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 344.8, "maximum": 1417.85, "gross_charge": 604.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 453.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 483.93, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 544.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 344.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREAT DISTAL RADIAL FRACTURE", "code_information": [{"code": "25605", "type": "CPT"}, {"code": "11000331", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1165.82, "maximum": 1840.77, "gross_charge": 2045.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1533.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1636.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1840.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1165.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREAT HUMERAL FX W MANIPULATION", "code_information": [{"code": "24535", "type": "CPT"}, {"code": "11000936", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 903.11, "maximum": 1425.97, "gross_charge": 1584.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1188.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1267.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1425.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 903.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREAT RAD HEAD SUB IN CHILD", "code_information": [{"code": "24640", "type": "CPT"}, {"code": "11000935", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 148.03, "maximum": 233.73, "gross_charge": 259.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 194.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 207.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 233.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 148.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREAT SHOULDER DISLOCATION W/MAN", "code_information": [{"code": "23650", "type": "CPT"}, {"code": "11000231", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 367.47, "maximum": 1417.85, "gross_charge": 644.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 483.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 515.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 580.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 367.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TREAT THUMB W MANIPULATION", "code_information": [{"code": "26641", "type": "CPT"}, {"code": "11000431", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 940.79, "maximum": 1485.45, "gross_charge": 1650.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1237.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1320.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1485.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 940.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TRTMT INTERPHALANGEAL JOINT DISLO", "code_information": [{"code": "26770", "type": "CPT"}, {"code": "11000295", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 367.65, "maximum": 1417.85, "gross_charge": 645.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 367.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TRTMT KNEE DISLOCATION W/O ANESTH", "code_information": [{"code": "27550", "type": "CPT"}, {"code": "11000496", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1087.73, "maximum": 1717.47, "gross_charge": 1908.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1431.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1526.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1717.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1087.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX NOSE/JAW FX", "code_information": [{"code": "21345", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/MANIPULJ", "code_information": [{"code": "21401", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/O MANIPULJ", "code_information": [{"code": "21400", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSED TX SEPTAL&NOSE FX", "code_information": [{"code": "21337", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/MANJ", "code_information": [{"code": "22315", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/O MANJ", "code_information": [{"code": "22310", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM DIFFICILE TOXIN GENE NAA", "code_information": [{"code": "87493", "type": "CPT"}, {"code": "1000929", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 33.38, "maximum": 180.9, "gross_charge": 201.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 160.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 180.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 114.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [{"code": "87803", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE DEV, VASC", "code_information": [{"code": "C1760", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF EYELID BY SUTURE", "code_information": [{"code": "67875", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "42600", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "D7983", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VAGINA", "code_information": [{"code": "57120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33602", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF WINDPIPE LESION", "code_information": [{"code": "31820", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/BOWEL FISTULA", "code_information": [{"code": "50930", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/SKIN FISTULA", "code_information": [{"code": "50920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR FLETCHER FACT", "code_information": [{"code": "85292", "type": "CPT"}], "standard_charges": [{"minimum": 21.77, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR IX PTC/CHRSTMAS", "code_information": [{"code": "85250", "type": "CPT"}], "standard_charges": [{"minimum": 21.9, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VII PROCONVERTIN", "code_information": [{"code": "85230", "type": "CPT"}], "standard_charges": [{"minimum": 20.59, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII MULTIMETRIC", "code_information": [{"code": "85247", "type": "CPT"}], "standard_charges": [{"minimum": 26.38, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII VW RISTOCTN", "code_information": [{"code": "85245", "type": "CPT"}], "standard_charges": [{"minimum": 26.38, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR WGHT KININOGEN", "code_information": [{"code": "85293", "type": "CPT"}], "standard_charges": [{"minimum": 21.77, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XI PTA", "code_information": [{"code": "85270", "type": "CPT"}], "standard_charges": [{"minimum": 20.59, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XII HAGEMAN", "code_information": [{"code": "85280", "type": "CPT"}], "standard_charges": [{"minimum": 22.25, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XIII FIBRIN SCRN", "code_information": [{"code": "85291", "type": "CPT"}], "standard_charges": [{"minimum": 10.48, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XIII FIBRIN STAB", "code_information": [{"code": "85290", "type": "CPT"}], "standard_charges": [{"minimum": 18.79, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT INHIBIT PROT C ACTIVITY", "code_information": [{"code": "85303", "type": "CPT"}], "standard_charges": [{"minimum": 15.92, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT INHIBIT PROT S FREE", "code_information": [{"code": "85306", "type": "CPT"}], "standard_charges": [{"minimum": 17.62, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOTTING ASSAY WHOLE BLOOD", "code_information": [{"code": "85396", "type": "CPT"}], "standard_charges": [{"minimum": 21.82, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOTTING FUNCT ACTIVITY", "code_information": [{"code": "85397", "type": "CPT"}], "standard_charges": [{"minimum": 35.49, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 35.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOZAPINE, 25 MG", "code_information": [{"code": "S0136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD RED COMP MALAR/ZYGMA FX", "code_information": [{"code": "D7760", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD RED SIMP MALAR/ZYGOM FX", "code_information": [{"code": "D7660", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD RED SIMPL MANDIBLE FX", "code_information": [{"code": "D7640", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD REDUCT COMPD MANDBLE FX", "code_information": [{"code": "D7740", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD REDUCT COMPD MAXILLA FX", "code_information": [{"code": "D7720", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD REDUCT SIMPL MAXILLA FX", "code_information": [{"code": "D7620", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD TX NSL FX MNPJ WO STBLJ", "code_information": [{"code": "21315", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD TX NSL FX W/MNPJ&STABLJ", "code_information": [{"code": "21320", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27197", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27198", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC W/MNPJ", "code_information": [{"code": "23545", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC WO MNPJ", "code_information": [{"code": "23540", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/MNPJ", "code_information": [{"code": "23505", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/O MNPJ", "code_information": [{"code": "23500", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX W/MNPJ", "code_information": [{"code": "23625", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX WO MNPJ", "code_information": [{"code": "23620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX MED ANKLE FX W/MNPJ", "code_information": [{"code": "27762", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX MEDIAL ANKLE FX", "code_information": [{"code": "27760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX", "code_information": [{"code": "27767", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX W/MNPJ", "code_information": [{"code": "27768", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX PROX HUMRL FX W/O MNPJ", "code_information": [{"code": "23600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX PRX HMRL FX MNPJ+-TRACT", "code_information": [{"code": "23605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [{"code": "23575", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX SCAPULAR FX W/O MNPJ", "code_information": [{"code": "23570", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [{"code": "23675", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [{"code": "23665", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC W/MNPJ W/ANES", "code_information": [{"code": "23655", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/MNPJ", "code_information": [{"code": "23525", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/O MNPJ", "code_information": [{"code": "23520", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX", "code_information": [{"code": "27267", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX W/MNPJ", "code_information": [{"code": "27268", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMBN ANT PST COLPRHY", "code_information": [{"code": "57260", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMBN AP COLPRHY W/NTRCL RPR", "code_information": [{"code": "57265", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH 10-20MIN", "code_information": [{"code": "G9869", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH <10MIN", "code_information": [{"code": "G9868", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH >20MIN", "code_information": [{"code": "G9870", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMMI MOD HOME VISIT", "code_information": [{"code": "G9490", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMP NEW", "code_information": [{"code": "80053", "type": "CPT"}, {"code": "1400018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.14, "maximum": 56.32, "gross_charge": 62.58, "discounted_cash": 54.17, "estimated_discounted_cash": 63.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.06, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 56.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPRTV DNA ALYS MLT SNPS", "code_information": [{"code": "79U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH DX IMG ANT SEGMT", "code_information": [{"code": "92132", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH IMG OPTIC NERVE", "code_information": [{"code": "92133", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMS 2728 COMPLETED", "code_information": [{"code": "M1265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMV IG IV", "code_information": [{"code": "90291", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMV-PCR QUANT", "code_information": [{"code": "87497", "type": "CPT"}, {"code": "1000850", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 49.27, "maximum": 186.97, "gross_charge": 207.75, "discounted_cash": 54.17, "estimated_discounted_cash": 239.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 166.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 186.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 118.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNBP GENE DETC ABNOR ALLELE", "code_information": [{"code": "81187", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CNS DNA AMP PROBE TYPE 12-25", "code_information": [{"code": "87483", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 479.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 479.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CNSLNG CHLDBRNG WOMEN EPI", "code_information": [{"code": "4340F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CNSLNG EPI SPEC SFTY ISSUES", "code_information": [{"code": "4330F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CNSLNG PROVIDED SYMP MNGMNT", "code_information": [{"code": "4350F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CNSLT BEFORE SCREEN COLONOSC", "code_information": [{"code": "S0285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CNTCT LENS BLUE VIOLET", "code_information": [{"code": "V2526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CNVRT NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7547", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CO GNOTYP AQP1 EXON 1", "code_information": [{"code": "181U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CO-ENZYME (NF-Coenzyme) Q-10 Cap 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002858", "type": "CDM"}, {"code": "88395008240", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CO-MORBID CONDITION ASSESS", "code_information": [{"code": "1026F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CO/MEMBANE DIFFUSE CAPACITY", "code_information": [{"code": "94729", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CO2 DETECTOR ADULT", "code_information": [{"code": "3000124", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 39.57, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CO2 DETECTOR PED", "code_information": [{"code": "3000125", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 44.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CO57 CYANO", "code_information": [{"code": "A9559", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CO57/58", "code_information": [{"code": "A9546", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COAGULATION DISORDERS", "code_information": [{"code": "813", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME ACTIVATED", "code_information": [{"code": "85347", "type": "CPT"}], "standard_charges": [{"minimum": 4.92, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME LEE & WHITE", "code_information": [{"code": "85345", "type": "CPT"}], "standard_charges": [{"minimum": 5.39, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME OTR METHOD", "code_information": [{"code": "85348", "type": "CPT"}], "standard_charges": [{"minimum": 5.16, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COBALT", "code_information": [{"code": "83018", "type": "CPT"}, {"code": "1000846", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 25.25, "maximum": 115.2, "gross_charge": 128.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 102.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 72.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COBAN 1IN", "code_information": [{"code": "3001406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COBAN 2IN", "code_information": [{"code": "3001407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COBAN 3IN", "code_information": [{"code": "3000479", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.77, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COBAN 4IN", "code_information": [{"code": "3000480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COCAINE HCL NASAL (GOPRELTO)", "code_information": [{"code": "C9046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COCAINE HCL NASAL (NUMBRINO)", "code_information": [{"code": "C9143", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COCCIDIOIDES Abs, QN DID", "code_information": [{"code": "86635", "type": "CPT"}, {"code": "1000545", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.19, "maximum": 96.7, "gross_charge": 67.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCHLEAR IMPLT F/UP EXAM 7/>", "code_information": [{"code": "92603", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COCHLEAR IMPLT F/UP EXAM <7", "code_information": [{"code": "92601", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COCM BY RHC/FQHC 60 MIN MO", "code_information": [{"code": "G0512", "type": "HCPCS"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COCOON MEMBRANE, PER SQ CM", "code_information": [{"code": "Q4264", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COG&BEHAV IMPRMNT SCRNG DONE", "code_information": [{"code": "3755F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COGENEX AMNIO MEMB PER SQ CM", "code_information": [{"code": "Q4229", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COGENEX FLOW AMNION 0.5 CC", "code_information": [{"code": "Q4230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COGENTIN (BENZTROPINE) TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000238", "type": "CDM"}, {"code": "69315013701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COGNIT ASSESSED AND REVIEWED", "code_information": [{"code": "1494F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COGNIT IMPAIRMENT ASSESSED", "code_information": [{"code": "3720F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COGNITIVE TEST BY HC PRO", "code_information": [{"code": "96125", "type": "CPT"}], "standard_charges": [{"minimum": 1848.13, "maximum": 1848.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1848.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLACE (DOCUSATE SOD) LIQ 50MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000751", "type": "CDM"}, {"code": "00536130485", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLACE (DOCUSATE SODIUM) CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000166", "type": "CDM"}, {"code": "00904718361", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLCRYS TAB 0.6MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000811", "type": "CDM"}, {"code": "70010000201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLD AGGLUTINATION", "code_information": [{"code": "86157", "type": "CPT"}, {"code": "1000082", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.27, "maximum": 42.95, "gross_charge": 47.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 38.18, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 42.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLD AGGLUTININ SCREEN", "code_information": [{"code": "86156", "type": "CPT"}], "standard_charges": [{"minimum": 9.28, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/ILEOANAL ANAST", "code_information": [{"code": "44157", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/NEO-RECTUM POUCH", "code_information": [{"code": "44158", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "402T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "418U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLISTIMETHATE INH SOL MG", "code_information": [{"code": "S0142", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLISTIMETHATE SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0770", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLL-E-DERM 1 SQ CM", "code_information": [{"code": "Q4193", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLAGEN MENISCUS IMPLANT", "code_information": [{"code": "G0428", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLAGEN SKIN TEST", "code_information": [{"code": "Q3031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLAGENASE, CLOST HIST INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0775", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLAR HEAD BED ADULT/CHILD", "code_information": [{"code": "3001153", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLAR PHILADELPHIA W/TRACH 2-1/4 L", "code_information": [{"code": "3001400", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 45.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLAR PHILADELPHIA W/TRACH 2-1/4 M", "code_information": [{"code": "3001399", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 45.12, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLAR STIFNECK NO-NECK (ADULT)", "code_information": [{"code": "3001271", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.18, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLAR STIFNECK NO-NECK (BABY)", "code_information": [{"code": "3000133", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLAR STIFNECK PEDIATRIC", "code_information": [{"code": "3001151", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 21.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLAR STIFNECK REGULAR (ADULT)", "code_information": [{"code": "3001152", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 21.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLAR STIFNECK SHORT (ADULT)", "code_information": [{"code": "3000135", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLECT & APPL BLOOD PRODUCT", "code_information": [{"code": "D7921", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLECT & PREP GENETIC SAMP", "code_information": [{"code": "D0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLECT & PREP SALIVA SAMPLE", "code_information": [{"code": "D0417", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLECT BLOOD - CENTRAL CATH", "code_information": [{"code": "36592", "type": "CPT"}, {"code": "11000246", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT BLOOD - VENOUS DEVICE", "code_information": [{"code": "36591", "type": "CPT"}, {"code": "11000245", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT SWEAT FOR TEST", "code_information": [{"code": "89230", "type": "CPT"}], "standard_charges": [{"minimum": 2.49, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLECT URINE MID STREAM", "code_information": [{"code": "3000481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLLECTION FEE DRUG", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "1000231", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 38.72, "gross_charge": 20.0, "discounted_cash": 54.17, "estimated_discounted_cash": 104.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION OF MICROORGANISMS", "code_information": [{"code": "D0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLJ & INTERPJ DATA EA 30 D", "code_information": [{"code": "99091", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLJ CAPILLARY BLOOD SPEC", "code_information": [{"code": "36416", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN NOT HI RSK IND", "code_information": [{"code": "G0121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN;BLD-BSD BIOMRK", "code_information": [{"code": "G0327", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLON MOTILITY 6 HR STUDY", "code_information": [{"code": "91117", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY & POLYPECTOMY", "code_information": [{"code": "44392", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY AND BIOPSY", "code_information": [{"code": "45380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR BLEEDING", "code_information": [{"code": "44391", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR FOREIGN BODY", "code_information": [{"code": "44390", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY SUBMUCOUS NJX", "code_information": [{"code": "45381", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY THRU STOMA SPX", "code_information": [{"code": "44388", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ABLATION", "code_information": [{"code": "45388", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BALLOON DILAT", "code_information": [{"code": "45386", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BAND LIGATION", "code_information": [{"code": "45398", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/CONTROL BLEED", "code_information": [{"code": "45382", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "44408", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "45393", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DILATION", "code_information": [{"code": "44405", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPE US", "code_information": [{"code": "45391", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPIC FNB", "code_information": [{"code": "45392", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/FB REMOVAL", "code_information": [{"code": "45379", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/INJECTION", "code_information": [{"code": "44404", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/LESION REMOVAL", "code_information": [{"code": "45384", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/LESION REMOVAL", "code_information": [{"code": "45385", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/NDL ASPIR/BX", "code_information": [{"code": "44407", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "44403", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "45390", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/SNARE", "code_information": [{"code": "44394", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "44402", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "45389", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ULTRASOUND", "code_information": [{"code": "44406", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH ABLATION", "code_information": [{"code": "44401", "type": "CPT"}], "standard_charges": [{"minimum": 6531.95, "maximum": 6531.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6531.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH BIOPSY", "code_information": [{"code": "44389", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLOR CONT LENS", "code_information": [{"code": "S0514", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLORECTAL CA SCREEN DOC REV", "code_information": [{"code": "3017F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLORECTAL CA SCREEN DOC REV", "code_information": [{"code": "M1277", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLORECTAL CANCER MONITOR", "code_information": [{"code": "82378", "type": "CPT"}, {"code": "1000806", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.8, "maximum": 101.06, "gross_charge": 112.29, "discounted_cash": 54.17, "estimated_discounted_cash": 112.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 89.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLORECTAL SCRN; HI RISK IND", "code_information": [{"code": "G0105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY", "code_information": [{"code": "44320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY FLANGE 2 1/2", "code_information": [{"code": "3000137", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLOSTOMY IRRIGATION", "code_information": [{"code": "3000138", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COLOSTOMY WITH BIOPSIES", "code_information": [{"code": "44322", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY EXTRAPERITONEAL", "code_information": [{"code": "57282", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY INTRAPERITONEAL", "code_information": [{"code": "57283", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY, MIN/INV, EX-PERIT", "code_information": [{"code": "C9778", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COM CARE", "code_information": [{"code": "G9930", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COM WRAP-AROUND SV, 15 MIN", "code_information": [{"code": "H2021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COM WRAP-AROUND SV, PER DIEM", "code_information": [{"code": "H2022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMA STIMULATION PER DIEM", "code_information": [{"code": "S9056", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMB ART/VENOUS BLOOD TUBING", "code_information": [{"code": "A4755", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMB LARGE 8 5/8", "code_information": [{"code": "3001423", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMB/HAIR", "code_information": [{"code": "3000012", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMBINATION SIT TO STAND SYS", "code_information": [{"code": "E0637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "429", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC", "code_information": [{"code": "430", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COMBIVENT (ALBUT/IPRATROP) MDI 18MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000123", "type": "CDM"}, {"code": "00597002402", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 162.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMBO PEGINTF/RIB RX", "code_information": [{"code": "4153F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMBO THRPY OF >= 2 PROPHLY", "code_information": [{"code": "G9956", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMFEEL FLIM 4X4", "code_information": [{"code": "3000140", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMFEEL PLUS CLEAR DRSG 4X4", "code_information": [{"code": "3000141", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMFEEL PLUS CONTOUR DRSG", "code_information": [{"code": "3000142", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.54, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMFEEL PLUS DRSG 4X4", "code_information": [{"code": "3000143", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMFEEL PLUS DRSG 6X6", "code_information": [{"code": "3000144", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMFEEL PLUS PRESSURE RELEIF 4", "code_information": [{"code": "3000145", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMFEEL TRIAD 2.5OZ", "code_information": [{"code": "3000146", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMM BH CLINIC SVC PER DIEM", "code_information": [{"code": "T1040", "type": "HCPCS"}], "standard_charges": [{"minimum": 1671.13, "maximum": 1671.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1671.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMM BH CLINIC SVC PER MONTH", "code_information": [{"code": "T1041", "type": "HCPCS"}], "standard_charges": [{"minimum": 1671.13, "maximum": 1671.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1671.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMM HLTH INTG SVS ADD 30 M", "code_information": [{"code": "G0022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMM HLTH INTG SVS SDOH 60MN", "code_information": [{"code": "G0019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMM PSY FACE-FACE PER 15MIN", "code_information": [{"code": "H0036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMM PSY SUP TX PGM PER DIEM", "code_information": [{"code": "H0037", "type": "HCPCS"}], "standard_charges": [{"minimum": 973.08, "maximum": 973.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 973.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMM SVCS BY RHC/FQHC 5 MIN", "code_information": [{"code": "G0071", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMM TRANS WAIVER/SERVICE", "code_information": [{"code": "T2038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMMISSURE SPLINT", "code_information": [{"code": "D5987", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMMUNITY/WORK REINTEGRATION", "code_information": [{"code": "97537", "type": "CPT"}], "standard_charges": [{"minimum": 30.15, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP ASSES CARE PLAN CCM SVC", "code_information": [{"code": "G0506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP COMM SUPP SVC, 15 MIN", "code_information": [{"code": "H2015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP COMM SUPP SVC, PER DIEM", "code_information": [{"code": "H2016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP CONT LENS EVAL", "code_information": [{"code": "S0592", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP GENET TEST HYP CARDIOMY", "code_information": [{"code": "S3865", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP GERIATR ASSMT TEAM", "code_information": [{"code": "S0250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP IMAGE CAPTURE ONLY", "code_information": [{"code": "D0387", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP MGMT CARE COORD ADV ILL", "code_information": [{"code": "S0311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP MULTIDISIPLN EVALUATION", "code_information": [{"code": "H2000", "type": "HCPCS"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP PERIODONTAL EVALUATION", "code_information": [{"code": "D0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMP PREOP ASSESS CAT SURG", "code_information": [{"code": "14F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPACT TRAVEL HEMODIALYZER", "code_information": [{"code": "E1635", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPATIBILITY TEST ELECTRIC", "code_information": [{"code": "86923", "type": "CPT"}], "standard_charges": [{"minimum": 28.98, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPATIBILITY TEST SPIN", "code_information": [{"code": "86920", "type": "CPT"}], "standard_charges": [{"minimum": 13.73, "maximum": 36.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPAZINE (PROCHLORPERAZINE) 5MG/ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0780", "type": "HCPCS"}, {"code": "72000303", "type": "CDM"}, {"code": "55390007710", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 26.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPAZINE (PROCHLORPERAZINE) SUPP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000384", "type": "CDM"}, {"code": "00713013512", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COMPAZINE (PROCHLORPERAZINE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "Q0164", "type": "HCPCS"}, {"code": "7000385", "type": "CDM"}, {"code": "00904738106", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPAZINE(PROCHLORPERAZ5MG/ML INJ:2ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0780", "type": "HCPCS"}, {"code": "7000386", "type": "CDM"}, {"code": "00641049125", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 26.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPL GIFT CASE RATE", "code_information": [{"code": "S4013", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPL OPH EXAM GENERAL ANES", "code_information": [{"code": "92018", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPL RPLCMT PICC RS&I", "code_information": [{"code": "36584", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPL ZIFT CASE RATE", "code_information": [{"code": "S4014", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT C1q ESTERASE INHIBITOR", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "1000615", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.8, "maximum": 63.96, "gross_charge": 71.07, "discounted_cash": 54.17, "estimated_discounted_cash": 71.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT FIXATION EACH", "code_information": [{"code": "86171", "type": "CPT"}], "standard_charges": [{"minimum": 11.51, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT TOTAL (CH50)", "code_information": [{"code": "86162", "type": "CPT"}, {"code": "1000492", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 23.37, "maximum": 108.24, "gross_charge": 120.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 96.21, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 108.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT/FUNCTION ACTIVITY", "code_information": [{"code": "86161", "type": "CPT"}], "standard_charges": [{"minimum": 13.8, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE AA, PER SQ CM", "code_information": [{"code": "Q4303", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE ACA, PER SQ CM", "code_information": [{"code": "Q4302", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE FT PER SQ CM", "code_information": [{"code": "Q4271", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE IVF NOS CASE RATE", "code_information": [{"code": "S4015", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE OCCLUSAL ADJUSTMENT", "code_information": [{"code": "D9952", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE PHYS SKIN EXAM DONE", "code_information": [{"code": "2029F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE REMOVAL OF VULVA", "code_information": [{"code": "56625", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE SL PER SQ CM", "code_information": [{"code": "Q4270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETED EPSDT", "code_information": [{"code": "S0302", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETION PNEUMONECTOMY", "code_information": [{"code": "32488", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLEX CYSTOMETROGRAM", "code_information": [{"code": "51726", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLEX E/M VISIT ADD ON", "code_information": [{"code": "G2211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLEX LYMPHEDEMA THERAPY,", "code_information": [{"code": "S8950", "type": "HCPCS"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [{"code": "381", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "380", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITHOUT CC/MCC", "code_information": [{"code": "382", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [{"code": "920", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [{"code": "919", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITHOUT CC/MCC", "code_information": [{"code": "921", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 2 VEINS", "code_information": [{"code": "35682", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 3/> SEGMT", "code_information": [{"code": "35683", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT PROS&VEIN", "code_information": [{"code": "35681", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPOSITE DRSG > 48 SQ IN", "code_information": [{"code": "A6205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPOSITE SKIN GRAFT", "code_information": [{"code": "15760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPOUNDED DRUG, NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE AUDIOMETRY EVALUATION", "code_information": [{"code": "212T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE DENTAL TX ADOLESCENT", "code_information": [{"code": "D8080", "type": "HCPCS"}], "standard_charges": [{"minimum": 1179.44, "maximum": 1179.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1179.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE DENTAL TX ADULT", "code_information": [{"code": "D8090", "type": "HCPCS"}], "standard_charges": [{"minimum": 1179.44, "maximum": 1179.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1179.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE DENTAL TX TRANSITION", "code_information": [{"code": "D8070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1179.44, "maximum": 1179.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1179.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL ABLTJ ATR FIB", "code_information": [{"code": "93656", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL TX SVT", "code_information": [{"code": "93653", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL TX VT", "code_information": [{"code": "93654", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE FUL BDY 3D MTN ALYS", "code_information": [{"code": "693T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE OPH EXAM EST PT 1/>", "code_information": [{"code": "92014", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRE OPH EXAM NEW PT 1/>", "code_information": [{"code": "92004", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE HEARING TEST", "code_information": [{"code": "92557", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE MED SVC 15 MIN", "code_information": [{"code": "H2010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE METABOLIC PANEL BABY", "code_information": [{"code": "80053", "type": "CPT"}, {"code": "1000154", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.14, "maximum": 56.32, "gross_charge": 62.58, "discounted_cash": 54.17, "estimated_discounted_cash": 63.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.06, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 56.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPREHENSVE ORAL EVALUATION", "code_information": [{"code": "D0150", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRES BURN GARMENT, NOC", "code_information": [{"code": "A6512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRESSION BANDAGE", "code_information": [{"code": "S8431", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRESSION FORM SHOE INSERT", "code_information": [{"code": "A5510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPRSSION THXPY PRESCRIBED", "code_information": [{"code": "4267F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMT GENE", "code_information": [{"code": "32U", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMTAN (ENTACOPONE) TAB 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000311", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CON TISSUE W PEDICLE GRAFT", "code_information": [{"code": "D4276", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [{"code": "212", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION", "code_information": [{"code": "317", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH CC", "code_information": [{"code": "89", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH MCC", "code_information": [{"code": "88", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITHOUT CC/MCC", "code_information": [{"code": "90", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CONDITIONING PLAY AUDIOMETRY", "code_information": [{"code": "92582", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT BOTH JAWS", "code_information": [{"code": "D0383", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPT & INTERP", "code_information": [{"code": "D0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPT MANDIBLE", "code_information": [{"code": "D0381", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPT MAXILLA", "code_information": [{"code": "D0382", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPTURE LIMITED", "code_information": [{"code": "D0380", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPTURE TMJ", "code_information": [{"code": "D0384", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERP BOTH JAW", "code_information": [{"code": "D0367", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE MAN", "code_information": [{"code": "D0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE MAX", "code_information": [{"code": "D0366", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE TMJ", "code_information": [{"code": "D0368", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONFIRMATORY RMSF IgG IFA", "code_information": [{"code": "86757", "type": "CPT"}, {"code": "1000781", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 22.25, "maximum": 103.11, "gross_charge": 114.57, "discounted_cash": 54.17, "estimated_discounted_cash": 114.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 91.65, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONFORMAL RADN THXPY RCVD", "code_information": [{"code": "4181F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONFORMITY EVALUATION", "code_information": [{"code": "V5020", "type": "HCPCS"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONGO RED BLOOD TEST", "code_information": [{"code": "P2029", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.73, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONIVAPTAN HCL", "code_information": [{"code": "C9488", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX", "code_information": [{"code": "57520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX", "code_information": [{"code": "57522", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONN TISS, HUMAN(INC FASCIA)", "code_information": [{"code": "C1762", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONN TISS, NON-HUMAN", "code_information": [{"code": "C1763", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "546", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "545", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "547", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CONNECTOR , RAPID RED", "code_information": [{"code": "3001451", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 1.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CONNECTOR CLAVE", "code_information": [{"code": "3001332", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CONSLTJ COMPRE RVW REC REPRT", "code_information": [{"code": "88325", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 151.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 151.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSLTJ&REPRT MATRL PREP SLD", "code_information": [{"code": "88323", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 124.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 124.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSLTJ&REPRT SLD PREP ELSWR", "code_information": [{"code": "88321", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 93.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 93.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BLADDER OPENING", "code_information": [{"code": "51980", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50825", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT THUMB REPLACEMENT", "code_information": [{"code": "26550", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT VAGINA WITH GRAFT", "code_information": [{"code": "57292", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46730", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46735", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46740", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF VAGINA", "code_information": [{"code": "57291", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSULT INC PREP OF SLIDES", "code_information": [{"code": "D0485", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSULT SLIDES PREP ELSEWHER", "code_information": [{"code": "D0484", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.12, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSULT W/MED HLTH CARE PROF", "code_information": [{"code": "D9311", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSULTATION WITH FAMILY", "code_information": [{"code": "90887", "type": "CPT"}], "standard_charges": [{"minimum": 481.58, "maximum": 481.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 481.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR ANALYSIS I&R", "code_information": [{"code": "95251", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PHYS/QHP EQP", "code_information": [{"code": "95250", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PT PROV EQP", "code_information": [{"code": "95249", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONT INTRAOP NEURO MONITOR", "code_information": [{"code": "G0453", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTACT LAYER <= 16 SQ IN", "code_information": [{"code": "A6206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTACT LAYER > 48 SQ IN", "code_information": [{"code": "A6208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA 1", "code_information": [{"code": "92311", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA OU", "code_information": [{"code": "92312", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING FOR TX", "code_information": [{"code": "92071", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING OU", "code_information": [{"code": "92310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS/ES OTHER TYPE", "code_information": [{"code": "V2599", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTINUOUS O2 SATURATION MONITORING", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "4200010", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 113.74, "maximum": 179.6, "gross_charge": 199.56, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 149.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 159.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 179.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 113.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTINUOUS PPI OR H2RA RCVD", "code_information": [{"code": "4185F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTINUOUS PULSE OXIMETRY", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "11000254", "type": "CDM"}, {"code": "469", "type": "RC"}], "standard_charges": [{"minimum": 166.12, "maximum": 368.06, "gross_charge": 408.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 306.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 327.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 368.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 233.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTOUR BACK FOR PED SIZE WC", "code_information": [{"code": "E2293", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTOUR CRANIAL BONE LESION", "code_information": [{"code": "21181", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTOUR OF FACE BONE LESION", "code_information": [{"code": "21029", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTOUR SEAT FOR PED SIZE WC", "code_information": [{"code": "E2294", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRACEPT IUD", "code_information": [{"code": "S4989", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRACEPTIVE HORMONE PATCH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7304", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRACEPTIVE PILLS FOR BC", "code_information": [{"code": "S4993", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRACTED SERVICES PER DAY", "code_information": [{"code": "T1022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM ABDOMINL AORTA", "code_information": [{"code": "75625", "type": "CPT"}], "standard_charges": [{"minimum": 166.33, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 166.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75600", "type": "CPT"}], "standard_charges": [{"minimum": 237.53, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 237.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75605", "type": "CPT"}], "standard_charges": [{"minimum": 156.34, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 156.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY BLADDER", "code_information": [{"code": "74430", "type": "CPT"}], "standard_charges": [{"minimum": 51.9, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY GALLBLADDER", "code_information": [{"code": "74290", "type": "CPT"}], "standard_charges": [{"minimum": 111.64, "maximum": 111.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 111.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ANKLE", "code_information": [{"code": "73615", "type": "CPT"}], "standard_charges": [{"minimum": 169.69, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 169.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70010", "type": "CPT"}], "standard_charges": [{"minimum": 77.74, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 77.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70015", "type": "CPT"}], "standard_charges": [{"minimum": 218.76, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 218.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ELBOW", "code_information": [{"code": "73085", "type": "CPT"}], "standard_charges": [{"minimum": 144.38, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 144.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF HIP", "code_information": [{"code": "73525", "type": "CPT"}], "standard_charges": [{"minimum": 170.94, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 170.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF KNEE JOINT", "code_information": [{"code": "73580", "type": "CPT"}], "standard_charges": [{"minimum": 188.39, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF SHOULDER", "code_information": [{"code": "73040", "type": "CPT"}], "standard_charges": [{"minimum": 168.02, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 168.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF WRIST", "code_information": [{"code": "73115", "type": "CPT"}], "standard_charges": [{"minimum": 174.24, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 174.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRCP TALK B/4 ANTIV TXMNT", "code_information": [{"code": "4159F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL ASSURE PRO", "code_information": [{"code": "80000857", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 10.53, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42970", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42971", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42972", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42960", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42961", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42962", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL UNIT BOWEL SYSTEM", "code_information": [{"code": "E0350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL UNIT NM STIM W PHONE", "code_information": [{"code": "E0492", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONVERSION EXT BIL DRG CATH", "code_information": [{"code": "47535", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONVERT NEPHROSTOMY CATHETER", "code_information": [{"code": "50434", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONZ OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57461", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COOL QUANT SENSORY TEST", "code_information": [{"code": "108T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COOMBS TEST INDIRECT TITER", "code_information": [{"code": "86886", "type": "CPT"}], "standard_charges": [{"minimum": 5.96, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COORD SPECIAL CARE ENCOUNTER", "code_information": [{"code": "H2041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COORD SPECIALTY CARE, MONTH", "code_information": [{"code": "H2040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COPD SYMPTOMS ASSESS", "code_information": [{"code": "1015F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COPING", "code_information": [{"code": "D2975", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COPPER CU 64 DOTATATE DIAG", "code_information": [{"code": "A9592", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COPPER LEVEL", "code_information": [{"code": "82525", "type": "CPT"}, {"code": "1000238", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.27, "maximum": 66.12, "gross_charge": 73.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 58.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 66.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 41.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPY NUMBER SEQUENCE ALYS", "code_information": [{"code": "156U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7516", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ILIC/FEM ANGIO", "code_information": [{"code": "C7517", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/FFR", "code_information": [{"code": "C7557", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ARTERY DISEASE MRNA", "code_information": [{"code": "81493", "type": "CPT"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS DOUBLE OSTEOT", "code_information": [{"code": "28299", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS DSTL MTAR OSTEO", "code_information": [{"code": "28296", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS JT ARTHRD", "code_information": [{"code": "28297", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX MTAR OSTEOT", "code_information": [{"code": "28295", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX PHLX OSTEOT", "code_information": [{"code": "28298", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS RSC PRX PHLX BS", "code_information": [{"code": "28292", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ FLOW RESRV", "code_information": [{"code": "C7519", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7518", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ILIC/FEM ANG", "code_information": [{"code": "C7520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD HARVESTING", "code_information": [{"code": "S2140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD-DERIVED STEM-CELL", "code_information": [{"code": "S2142", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORDARONE (AMIODARONE) 150MG/3ML INJ", "drug_information": {"unit": 5.0, "type": "EA"}, "code_information": [{"code": "J0282", "type": "HCPCS"}, {"code": "7000027", "type": "CDM"}, {"code": "00143987525", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 30.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORDARONE (AMIODARONE) TAB 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000133", "type": "CDM"}, {"code": "60687043701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CORE BUILD-UP INCL ANY PINS", "code_information": [{"code": "D2950", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORE NDL BX LNG/MED PERQ", "code_information": [{"code": "32408", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORECYTE TOPICAL ONLY 0.5 CC", "code_information": [{"code": "Q4240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COREG (CARVEDILOL) TAB 12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000101", "type": "CDM"}, {"code": "00904730761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COREG (CARVEDILOL) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000332", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COREG (CARVEDILOL) TAB 3.125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000723", "type": "CDM"}, {"code": "68382009201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COREG CR (CARVEDILOL PHOS) CAP 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000645", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CORETEXT OR PROTEXT, PER CC", "code_information": [{"code": "Q4246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORF RELATED SERV 15 MINS EA", "code_information": [{"code": "G0409", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORF SKILLED NURSING SERVICE", "code_information": [{"code": "G0128", "type": "HCPCS"}], "standard_charges": [{"minimum": 589.34, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORKBOARD 2'X3'", "code_information": [{"code": "80000828", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CORNEAL HYSTERESIS DETER", "code_information": [{"code": "92145", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL SMEAR", "code_information": [{"code": "65430", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE PROCESSING", "code_information": [{"code": "V2785", "type": "HCPCS"}], "standard_charges": [{"minimum": 8392.47, "maximum": 8392.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8392.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE TRANSPLANT", "code_information": [{"code": "65767", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65710", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65730", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65750", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65755", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRNSPL ENDOTHELIAL", "code_information": [{"code": "65756", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ART/GRFT ANGIO S&I", "code_information": [{"code": "93455", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY ANGIO S&I", "code_information": [{"code": "93454", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY BYPASS/REOP", "code_information": [{"code": "33530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY CORRECTION", "code_information": [{"code": "33502", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33503", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33504", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [{"code": "233", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [{"code": "234", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [{"code": "231", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [{"code": "232", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "235", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "236", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [{"code": "323", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "324", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [{"code": "325", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CORONECTOMY", "code_information": [{"code": "D7251", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONERS AUTOPSY (NECROPSY)", "code_information": [{"code": "88045", "type": "CPT"}], "standard_charges": [{"minimum": 60.08, "maximum": 60.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORPLEX, PER SQ CM", "code_information": [{"code": "Q4232", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT FINGER DEFORMITY", "code_information": [{"code": "26567", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT INVERTED NIPPLE(S)", "code_information": [{"code": "19355", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT MALROTATION OF BOWEL", "code_information": [{"code": "44055", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT METACARPAL FLAW", "code_information": [{"code": "26565", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45541", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR 6.0 CM/<", "code_information": [{"code": "11920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR EA 20.0CM", "code_information": [{"code": "11922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT SKN COLOR 6.1-20.0CM", "code_information": [{"code": "11921", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECTION EYELID W/IMPLANT", "code_information": [{"code": "67912", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65772", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65775", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF BLADDER DEFECT", "code_information": [{"code": "51940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRJ HALUX RIGDUS W/IMPLT", "code_information": [{"code": "28291", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRJ HALUX RIGDUS W/O IMPLT", "code_information": [{"code": "28289", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORTEF (HYDROCORTISONE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004337", "type": "CDM"}, {"code": "00009001201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CORTICORELIN OVINE TRIFLUTAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0795", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORTICOSTER SPARNG THRPY RXD", "code_information": [{"code": "4142F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORTICOTOMY, 1-3 TEETH", "code_information": [{"code": "D7296", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORTICOTOMY, 4 OR MORE TEETH", "code_information": [{"code": "D7297", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORTISOL", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "1000120", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.75, "maximum": 103.37, "gross_charge": 96.51, "discounted_cash": 54.17, "estimated_discounted_cash": 98.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 86.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL SERUM AM", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "1000420", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.75, "maximum": 103.37, "gross_charge": 96.51, "discounted_cash": 54.17, "estimated_discounted_cash": 98.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 86.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL URINE FREE, 24 HR", "code_information": [{"code": "82530", "type": "CPT"}, {"code": "1000237", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.22, "maximum": 89.04, "gross_charge": 98.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.15, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISPORIN (NEO/POLY/HC) 1% OTIC SOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000346", "type": "CDM"}, {"code": "24208063110", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CORTISPORIN (NEO/POLY/HC) OPTH GTTS 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000169", "type": "CDM"}, {"code": "24208063562", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 34.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CORTISPORIN (NEOMYCIN) 0.25% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000125", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 115.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COSOPT OPHTHALMIC SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004150", "type": "CDM"}, {"code": "82584060510", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 709.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COT RENTAL", "code_information": [{"code": "3000638", "type": "CDM"}, {"code": "995", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COUMADIN (WARFARIN SODIUM) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000127", "type": "CDM"}, {"code": "00832121301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COUMADIN (WARFARIN SODIUM) TAB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000128", "type": "CDM"}, {"code": "00832121201", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COUMADIN (WARFARIN SODIUM) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000129", "type": "CDM"}, {"code": "00832121601", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COUMADIN (WARFARIN SODIUM) TAB 7.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000420", "type": "CDM"}, {"code": "00832121801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COUNS FOR HIGH RISK SUB USE", "code_information": [{"code": "D1321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COUNS POTENT GLAUC IMPCT", "code_information": [{"code": "4174F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COUNSEL IMMUNE <21  5-15 M", "code_information": [{"code": "G0315", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COUNSEL IMMUNE <21 16-30 M", "code_information": [{"code": "G0314", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COUNSEL PROV DRIVING RISKS", "code_information": [{"code": "6110F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE", "code_information": [{"code": "65778", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE SUTURE", "code_information": [{"code": "65779", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COVID TEST SELF-ADMN/COLLECT", "code_information": [{"code": "K1034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COVID-19 CONVALESCENT PLASMA", "code_information": [{"code": "C9507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COVID-19 LAB TEST NON-CDC", "code_information": [{"code": "U0002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COVID-19 RAPID ANTIGEN", "code_information": [{"code": "87426", "type": "CPT"}, {"code": "1001012", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 45.23, "maximum": 103.5, "gross_charge": 115.0, "discounted_cash": 54.17, "estimated_discounted_cash": 115.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COZAAR (LOSARTAN POT) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000994", "type": "CDM"}, {"code": "65862020390", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "COZAAR (LOSARTAN POT) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000966", "type": "CDM"}, {"code": "68084034601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CPAP BREATHING CIRCUIT", "code_information": [{"code": "3001353", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CPAP INITIATION & MANAGEMENT", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "10000014", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 318.7, "maximum": 2054.3, "gross_charge": 559.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 419.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 447.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2054.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 503.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 318.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPK ISO", "code_information": [{"code": "82552", "type": "CPT"}, {"code": "1000148", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.4, "maximum": 71.36, "gross_charge": 79.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.43, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE 1ST 60 MIN", "code_information": [{"code": "99487", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE EA ADDL 30", "code_information": [{"code": "99489", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CPM DEVICE, OTHER THAN KNEE", "code_information": [{"code": "E0936", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CPR MOUTH BARRIER", "code_information": [{"code": "3000150", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CPTR OPHTH DX IMG POST SEGMT", "code_information": [{"code": "92134", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CPTR-ASST DIR MS PX", "code_information": [{"code": "20985", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CPTRIZED CORNEAL TOPOGRAPHY", "code_information": [{"code": "92025", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CR51 CHROMATE", "code_information": [{"code": "A9553", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [{"code": "73", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [{"code": "74", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 4734.53, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CRANIAL PROSTHESIS", "code_information": [{"code": "D5924", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIAL REMOLDING ORTHOSIS", "code_information": [{"code": "S1040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61580", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61581", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61582", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61583", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "26", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "25", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "27", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "955", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [{"code": "23", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [{"code": "24", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "CRAY VALLEY CO BMP", "code_information": [{"code": "80048", "type": "CPT"}, {"code": "1000604", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.73, "maximum": 72.0, "gross_charge": 80.0, "discounted_cash": 54.17, "estimated_discounted_cash": 50.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRAY VALLEY CO LAB", "code_information": [{"code": "1000275", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRAY VALLEY CO LFT", "code_information": [{"code": "80076", "type": "CPT"}, {"code": "1000603", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.4, "maximum": 72.0, "gross_charge": 80.0, "discounted_cash": 54.17, "estimated_discounted_cash": 51.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRAY VALLEY CO LIPID", "code_information": [{"code": "1000230", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRC NO DOC NO RSN", "code_information": [{"code": "M1315", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRD C HRT DS 9 GEN 12 VRNTS", "code_information": [{"code": "417U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRD CAD ALYS 3 PRTN 3 PARAM", "code_information": [{"code": "308U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRD CERAMIDES LIQ CHROM PLSM", "code_information": [{"code": "119U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRD CV DS ALY 4 PRTN PLM ALG", "code_information": [{"code": "309U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRD HRT TRNSPL MRNA 1283 GEN", "code_information": [{"code": "87U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69433", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69436", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATE NEW TUBAL OPENING", "code_information": [{"code": "58770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATE PASSAGE TO KIDNEY", "code_information": [{"code": "52334", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68745", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68750", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR SAC DRAIN", "code_information": [{"code": "68720", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATINE ISOFORMS", "code_information": [{"code": "82554", "type": "CPT"}], "standard_charges": [{"minimum": 13.65, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATINE KINASE (CK)", "code_information": [{"code": "82550", "type": "CPT"}, {"code": "10000149", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.49, "maximum": 71.36, "gross_charge": 79.29, "discounted_cash": 54.17, "estimated_discounted_cash": 79.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.43, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATINE KINASE (CK)", "code_information": [{"code": "82550", "type": "CPT"}, {"code": "1000149", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.49, "maximum": 71.36, "gross_charge": 79.29, "discounted_cash": 54.17, "estimated_discounted_cash": 79.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.43, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE 24HR UR", "code_information": [{"code": "82540", "type": "CPT"}, {"code": "1000146", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.34, "maximum": 24.67, "gross_charge": 27.42, "discounted_cash": 54.17, "estimated_discounted_cash": 27.42, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 21.93, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 15.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE BLOOD", "code_information": [{"code": "82565", "type": "CPT"}, {"code": "1000151", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.89, "maximum": 27.29, "gross_charge": 30.33, "discounted_cash": 54.17, "estimated_discounted_cash": 30.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE CLEARANCE 24HR UR", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "1000328", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 27.56, "gross_charge": 30.63, "discounted_cash": 54.17, "estimated_discounted_cash": 23.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE CLEARANCE TEST", "code_information": [{"code": "82575", "type": "CPT"}], "standard_charges": [{"minimum": 10.88, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CREATININE RANDOM UR", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "1099021", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 78.32, "gross_charge": 87.03, "discounted_cash": 54.17, "estimated_discounted_cash": 23.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE, URINE", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "1100095", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 15.64, "gross_charge": 15.54, "discounted_cash": 54.17, "estimated_discounted_cash": 23.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE/PROTEIN RATIO URINE", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "1000646", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 27.56, "gross_charge": 30.63, "discounted_cash": 54.17, "estimated_discounted_cash": 23.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREON 12000 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000899", "type": "CDM"}, {"code": "00032121201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CREON 36,000U CAPS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003290", "type": "CDM"}, {"code": "00032301613", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 23.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRESTOR (ROSUVASTATIN CALC) 20MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003364", "type": "CDM"}, {"code": "50268071015", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRESTOR (ROSUVASTATIN CALC) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000776", "type": "CDM"}, {"code": "68462026290", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 11.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRESTOR (ROSUVASTATIN CALC) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000132", "type": "CDM"}, {"code": "65862029390", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRGVR PROV W/ ED ADDL RSRCS", "code_information": [{"code": "4322F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRH STIMULATION PANEL", "code_information": [{"code": "80412", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 921.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 921.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRICOTHYROTOMY CATH", "code_information": [{"code": "3000482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRICOTHYROTOMY CATH 4.0", "code_information": [{"code": "3001220", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRICOTHYROTOMY CATH 6.0", "code_information": [{"code": "3001205", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRICOTRACHEAL RESECTION", "code_information": [{"code": "31592", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVEN SVC, 15 MIN", "code_information": [{"code": "H2011", "type": "HCPCS"}], "standard_charges": [{"minimum": 541.85, "maximum": 541.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 541.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVEN WAIVER/DIEM", "code_information": [{"code": "T2034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVENTION MENTAL H", "code_information": [{"code": "S9485", "type": "HCPCS"}], "standard_charges": [{"minimum": 973.08, "maximum": 973.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 973.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVENTION PER HOUR", "code_information": [{"code": "S9484", "type": "HCPCS"}], "standard_charges": [{"minimum": 541.85, "maximum": 541.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 541.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRISIS PSYCHOTHERAPY 60M", "code_information": [{"code": "G0017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRIT CARE TELEHEA CONSULT 50", "code_information": [{"code": "G0509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRIT CARE TELEHEA CONSULT 60", "code_information": [{"code": "G0508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRITIC AID 2.5OZ", "code_information": [{"code": "3000151", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRITIC AID 6OZ", "code_information": [{"code": "3000152", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 17.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRITICAL CARE EVAL 1ST HOURS", "code_information": [{"code": "99291", "type": "CPT"}, {"code": "11000301", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1184.48, "maximum": 1870.23, "gross_charge": 2078.04, "discounted_cash": 54.17, "estimated_discounted_cash": 2079.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1558.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1662.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1870.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1184.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CARE EVAL ADDTL 30 MIN", "code_information": [{"code": "99292", "type": "CPT"}, {"code": "11000300", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 592.24, "maximum": 935.11, "gross_charge": 1039.02, "discounted_cash": 54.17, "estimated_discounted_cash": 1632.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 779.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 831.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 935.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 592.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT<5 CM DIAM", "code_information": [{"code": "62140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT>5 CM DIAM", "code_information": [{"code": "62141", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT<5 CM DIAM", "code_information": [{"code": "62146", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT>5 CM DIAM", "code_information": [{"code": "62147", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROFAB (ANTIVENIN CROTALIDAE) 1 GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0840", "type": "HCPCS"}, {"code": "7000131", "type": "CDM"}, {"code": "50633011012", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4796.49, "maximum": 16454.23, "gross_charge": 8414.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6311.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 6731.92, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 7573.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 4796.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROM GNOTYP CD55 EXONS 1-10", "code_information": [{"code": "182U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROMOLYN SODIUM COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7632", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROMOLYN SODIUM NONCOMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROSS-OVER VEIN GRAFT", "code_information": [{"code": "34520", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROUPETTE NEBULIZER", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "4200002", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 60.0, "maximum": 94.74, "gross_charge": 105.27, "discounted_cash": 54.17, "estimated_discounted_cash": 3.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 94.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST BASE METAL", "code_information": [{"code": "D2781", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST BASED METAL", "code_information": [{"code": "D6781", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST HI NOBLE MET", "code_information": [{"code": "D2780", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST NOBLE METAL", "code_information": [{"code": "D2782", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST NOBLE METAL", "code_information": [{"code": "D6782", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 HIGH NOBLE METAL", "code_information": [{"code": "D6780", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 PORCELAIN/CERAMIC", "code_information": [{"code": "D2783", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 PORCELAIN/CERAMIC", "code_information": [{"code": "D6783", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 RESIN-BASED COMPOS", "code_information": [{"code": "D2712", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN FULL BASE METAL CAST", "code_information": [{"code": "D6791", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST BASE METAL", "code_information": [{"code": "D2791", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST HIGH NOBLE M", "code_information": [{"code": "D2790", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST NOBLE METAL", "code_information": [{"code": "D2792", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN FULL HIGH NOBLE METAL", "code_information": [{"code": "D6790", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN FULL NOBLE METAL CAST", "code_information": [{"code": "D6792", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN LENGTHEN HARD TISSUE", "code_information": [{"code": "D4249", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORC FUSED TO TITANIUM", "code_information": [{"code": "D2753", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN BASE METAL", "code_information": [{"code": "D6751", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN FUSED BASE M", "code_information": [{"code": "D2751", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN HIGH NOBLE", "code_information": [{"code": "D6750", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN NOBLE METAL", "code_information": [{"code": "D6752", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN W/ H NOBLE M", "code_information": [{"code": "D2750", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN W/ NOBLE MET", "code_information": [{"code": "D2752", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN/CERAMIC", "code_information": [{"code": "D2740", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN/CERAMIC", "code_information": [{"code": "D6740", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN REPAIR", "code_information": [{"code": "D2980", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ BASE METAL", "code_information": [{"code": "D2721", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ HIGH NOBLE ME", "code_information": [{"code": "D2720", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ NOBLE METAL", "code_information": [{"code": "D2722", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/BASE METAL", "code_information": [{"code": "D6721", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/NOBLE METAL", "code_information": [{"code": "D6722", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN-BASED INDIRECT", "code_information": [{"code": "D2710", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN TITANIUM", "code_information": [{"code": "D6794", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN-INDIRECT RESIN BASED", "code_information": [{"code": "D6710", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROWN-TITANIUM", "code_information": [{"code": "D2794", "type": "HCPCS"}], "standard_charges": [{"minimum": 6748.61, "maximum": 6748.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6748.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRUTCH ACCESSORTES K", "code_information": [{"code": "3000153", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRUTCH PAD", "code_information": [{"code": "3000154", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CRUTCH SUBSTITUTE", "code_information": [{"code": "E0118", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYO EMBRYO TRANSF CASE RATE", "code_information": [{"code": "S4037", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYO FIB COMP PATH REDU EACH", "code_information": [{"code": "P9026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYO-CORD, PER SQ CM", "code_information": [{"code": "Q4237", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE PROSTATE", "code_information": [{"code": "55873", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE RENAL MASS OPEN", "code_information": [{"code": "50250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOCAUTERY OF CERVIX", "code_information": [{"code": "57511", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOGLOBULIN", "code_information": [{"code": "82595", "type": "CPT"}, {"code": "1000560", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.44, "maximum": 38.72, "gross_charge": 38.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 34.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRECIPITATE EACH UNIT", "code_information": [{"code": "P9012", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOPRECIPITATEREDUCEDPLASMA", "code_information": [{"code": "P9044", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION EMBRYO(S)", "code_information": [{"code": "89258", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 487.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 487.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION OOCYTE(S)", "code_information": [{"code": "89337", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 517.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 517.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION SPERM", "code_information": [{"code": "89259", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 246.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 246.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE STEM CELLS", "code_information": [{"code": "38207", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE TESTICULAR TISS", "code_information": [{"code": "89335", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 132.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 132.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOSURG ABLATE FA EACH", "code_information": [{"code": "19105", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY ANAL LESION(S)", "code_information": [{"code": "46916", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY PENIS LESION(S)", "code_information": [{"code": "54056", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOTHERAPY OF SKIN", "code_information": [{"code": "17340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS ANTIBODY", "code_information": [{"code": "86641", "type": "CPT"}], "standard_charges": [{"minimum": 16.57, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS ANTIGEN, SERUM", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "1000927", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 18.48, "maximum": 103.5, "gross_charge": 115.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS NEOFORM AG IA", "code_information": [{"code": "87327", "type": "CPT"}], "standard_charges": [{"minimum": 15.43, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IA", "code_information": [{"code": "87328", "type": "CPT"}], "standard_charges": [{"minimum": 15.89, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IF", "code_information": [{"code": "87272", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM EIA", "code_information": [{"code": "87015", "type": "CPT"}, {"code": "1000324", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.68, "maximum": 35.58, "gross_charge": 39.54, "discounted_cash": 54.17, "estimated_discounted_cash": 39.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYSTAL EXAMINATION", "code_information": [{"code": "89060", "type": "CPT"}, {"code": "1000473", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.43, "maximum": 38.09, "gross_charge": 42.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 38.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 24.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF LEAKAGE IMAGING", "code_information": [{"code": "78650", "type": "CPT"}], "standard_charges": [{"minimum": 329.36, "maximum": 329.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 329.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT EVALUATION", "code_information": [{"code": "78645", "type": "CPT"}], "standard_charges": [{"minimum": 382.27, "maximum": 382.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 382.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT REPROGRAM", "code_information": [{"code": "62252", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSF VENTRICULOGRAPHY", "code_information": [{"code": "78635", "type": "CPT"}], "standard_charges": [{"minimum": 399.52, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 399.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSIT LOWRISK SURG PTS PREOP", "code_information": [{"code": "G8961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSIT ON PT ANY REAS 30 DAYS", "code_information": [{"code": "G8962", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CST BSE MTL INLAY 2 SURFACES", "code_information": [{"code": "D6604", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CST BSE MTL INLAY >= 3 SURFA", "code_information": [{"code": "D6605", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CST HGH NBLE MTL INLAY 2 SRF", "code_information": [{"code": "D6602", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CST HGH NBLE MTL INLAY >=3SR", "code_information": [{"code": "D6603", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CST NOBLE MTL INLAY >=3 SURF", "code_information": [{"code": "D6607", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSTB FULL GENE ANALYSIS", "code_information": [{"code": "232U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSTB GENE DETC ABNOR ALLELE", "code_information": [{"code": "81188", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSTB GENE FULL GENE SEQUENCE", "code_information": [{"code": "81189", "type": "CPT"}], "standard_charges": [{"minimum": 316.05, "maximum": 316.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSTB GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81190", "type": "CPT"}], "standard_charges": [{"minimum": 212.98, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSTM DME OTHER THAN WHEELCHR", "code_information": [{"code": "K0900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSTM MANUAL WHEELCHAIR/BASE", "code_information": [{"code": "K0008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ABD/PEL W/ AND W/O", "code_information": [{"code": "74178", "type": "CPT"}, {"code": "2200032", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 481.65, "maximum": 1302.96, "gross_charge": 1447.74, "discounted_cash": 54.17, "estimated_discounted_cash": 1447.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 481.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1158.19, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1302.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 825.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABD/PEL W/CONTRAST", "code_information": [{"code": "74177", "type": "CPT"}, {"code": "2200031", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 430.42, "maximum": 1302.96, "gross_charge": 1447.74, "discounted_cash": 54.17, "estimated_discounted_cash": 1447.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 430.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1158.19, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1302.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 825.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABD/PEL W/O CONTRAST", "code_information": [{"code": "74176", "type": "CPT"}, {"code": "2200030", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 256.72, "maximum": 1008.55, "gross_charge": 918.15, "discounted_cash": 54.17, "estimated_discounted_cash": 918.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 256.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 734.52, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 826.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 523.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W/ AND W/O", "code_information": [{"code": "74170", "type": "CPT"}, {"code": "2200002", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 324.24, "maximum": 1008.55, "gross_charge": 988.02, "discounted_cash": 54.17, "estimated_discounted_cash": 988.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 324.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 790.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 889.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 563.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W/ CONT", "code_information": [{"code": "74160", "type": "CPT"}, {"code": "2200003", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 315.63, "maximum": 1008.55, "gross_charge": 891.45, "discounted_cash": 54.17, "estimated_discounted_cash": 891.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 315.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 713.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 802.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 508.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W/O", "code_information": [{"code": "74150", "type": "CPT"}, {"code": "2200004", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 192.14, "maximum": 1008.55, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 192.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO ABD&PELV W/O&W/DYE", "code_information": [{"code": "74174", "type": "CPT"}], "standard_charges": [{"minimum": 532.94, "maximum": 1008.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 532.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIO ABDOM W/O & W/DYE", "code_information": [{"code": "74175", "type": "CPT"}], "standard_charges": [{"minimum": 351.44, "maximum": 1234.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 351.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1234.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIO ABDOMINAL ARTERIES", "code_information": [{"code": "75635", "type": "CPT"}], "standard_charges": [{"minimum": 388.26, "maximum": 1234.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 388.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1234.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIO HRT W/3D IMAGE", "code_information": [{"code": "75574", "type": "CPT"}], "standard_charges": [{"minimum": 389.13, "maximum": 389.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 389.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIO LWR EXTR W/O&W/DYE", "code_information": [{"code": "73706", "type": "CPT"}], "standard_charges": [{"minimum": 355.82, "maximum": 1234.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 355.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1234.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIO UPR EXTRM W/O&W/DYE", "code_information": [{"code": "73206", "type": "CPT"}], "standard_charges": [{"minimum": 350.09, "maximum": 1234.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 350.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1234.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPH PELV W/O&W/DYE", "code_information": [{"code": "72191", "type": "CPT"}], "standard_charges": [{"minimum": 350.51, "maximum": 1234.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 350.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1234.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPHY CHEST", "code_information": [{"code": "71275", "type": "CPT"}], "standard_charges": [{"minimum": 351.89, "maximum": 1234.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 351.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1234.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPHY HEAD", "code_information": [{"code": "70496", "type": "CPT"}], "standard_charges": [{"minimum": 347.14, "maximum": 347.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 347.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPHY NECK", "code_information": [{"code": "70498", "type": "CPT"}], "standard_charges": [{"minimum": 191.87, "maximum": 347.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 347.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT BONE DENSITY STUDY", "code_information": [{"code": "77078", "type": "CPT"}, {"code": "2200040", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 120.97, "maximum": 276.3, "gross_charge": 307.0, "discounted_cash": 54.17, "estimated_discounted_cash": 307.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 120.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 245.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 253.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 276.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 174.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C+", "code_information": [{"code": "637T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-", "code_information": [{"code": "636T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-/C+", "code_information": [{"code": "638T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C+", "code_information": [{"code": "634T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-", "code_information": [{"code": "633T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-/C+", "code_information": [{"code": "635T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT C-SPINE W/ CONT", "code_information": [{"code": "72126", "type": "CPT"}, {"code": "2200008", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 235.94, "maximum": 1232.19, "gross_charge": 1369.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 235.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1095.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1232.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 780.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT C-SPINE W/O", "code_information": [{"code": "72125", "type": "CPT"}, {"code": "2200009", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 181.46, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 181.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT C-SPINE W/WO CONT", "code_information": [{"code": "72127", "type": "CPT"}, {"code": "2200023", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 276.83, "maximum": 889.21, "gross_charge": 988.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 276.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 790.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 889.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 563.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST SPINE W/DYE", "code_information": [{"code": "72129", "type": "CPT"}], "standard_charges": [{"minimum": 237.68, "maximum": 237.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 237.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT CHEST SPINE W/O & W/DYE", "code_information": [{"code": "72130", "type": "CPT"}], "standard_charges": [{"minimum": 277.69, "maximum": 277.69, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 277.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT CHEST W/ CON FOR PE", "code_information": [{"code": "71260", "type": "CPT"}, {"code": "2200029", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 802.3, "gross_charge": 891.45, "discounted_cash": 54.17, "estimated_discounted_cash": 892.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 232.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 713.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 802.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 508.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST W/ CONTRAST", "code_information": [{"code": "71260", "type": "CPT"}, {"code": "2200006", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 802.3, "gross_charge": 891.45, "discounted_cash": 54.17, "estimated_discounted_cash": 892.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 232.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 713.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 802.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 508.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST W/O", "code_information": [{"code": "71250", "type": "CPT"}, {"code": "2200007", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 185.39, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 185.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST W/WO", "code_information": [{"code": "71270", "type": "CPT"}, {"code": "2200005", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 889.21, "gross_charge": 988.02, "discounted_cash": 54.17, "estimated_discounted_cash": 988.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 275.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 790.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 889.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 563.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY DX", "code_information": [{"code": "74261", "type": "CPT"}], "standard_charges": [{"minimum": 300.97, "maximum": 300.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 300.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY DX W/DYE", "code_information": [{"code": "74262", "type": "CPT"}], "standard_charges": [{"minimum": 397.1, "maximum": 397.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 397.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY SCREENING", "code_information": [{"code": "74263", "type": "CPT"}], "standard_charges": [{"minimum": 937.41, "maximum": 937.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 937.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT FACIAL W/ CONTRAST", "code_information": [{"code": "70487", "type": "CPT"}, {"code": "2200025", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 802.3, "gross_charge": 891.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 713.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 802.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 508.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT FACIAL W/O CONTRAST", "code_information": [{"code": "70486", "type": "CPT"}, {"code": "2200026", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 177.56, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 177.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT FACIAL W/WO CONTRAST", "code_information": [{"code": "70488", "type": "CPT"}, {"code": "2200024", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 889.21, "gross_charge": 988.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 258.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 790.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 889.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 563.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT GUIDE FOR TISSUE ABLATION", "code_information": [{"code": "77013", "type": "CPT"}], "standard_charges": [{"minimum": 296.96, "maximum": 671.53, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 671.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 296.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT HEAD W/ CONTRAST", "code_information": [{"code": "70460", "type": "CPT"}, {"code": "2200028", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 207.05, "maximum": 802.3, "gross_charge": 891.45, "discounted_cash": 54.17, "estimated_discounted_cash": 891.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 207.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 713.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 372.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 802.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 508.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HEAD W/O CONTRAST", "code_information": [{"code": "70450", "type": "CPT"}, {"code": "2200001", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 147.45, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 525.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 147.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 372.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HEAD W/WO CONTRAST", "code_information": [{"code": "70470", "type": "CPT"}, {"code": "2200027", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 243.2, "maximum": 889.21, "gross_charge": 988.02, "discounted_cash": 54.17, "estimated_discounted_cash": 988.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 243.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 790.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 372.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 889.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 563.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HRT C+ STRUX CGEN HRT DS", "code_information": [{"code": "75573", "type": "CPT"}], "standard_charges": [{"minimum": 400.47, "maximum": 400.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 400.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT HRT W/3D IMAGE", "code_information": [{"code": "75572", "type": "CPT"}], "standard_charges": [{"minimum": 317.03, "maximum": 317.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 317.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT HRT W/O DYE W/CA TEST", "code_information": [{"code": "75571", "type": "CPT"}], "standard_charges": [{"minimum": 136.8, "maximum": 136.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT L-SPINE W AND WO CONTRAST", "code_information": [{"code": "72133", "type": "CPT"}, {"code": "2200037", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 276.39, "maximum": 728.1, "gross_charge": 809.0, "discounted_cash": 54.17, "estimated_discounted_cash": 809.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 276.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 647.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 728.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 461.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT L-SPINE W/ CONTRAST", "code_information": [{"code": "72132", "type": "CPT"}, {"code": "2200036", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 235.94, "maximum": 1232.19, "gross_charge": 1369.11, "discounted_cash": 54.17, "estimated_discounted_cash": 1369.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 235.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1095.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1232.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 780.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT L-SPINE W/O CONTRAST", "code_information": [{"code": "72131", "type": "CPT"}, {"code": "2200011", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 180.59, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 180.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXT W AND W/O CONTRAST", "code_information": [{"code": "73702", "type": "CPT"}, {"code": "2200035", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 901.8, "gross_charge": 1002.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 272.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 801.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 901.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 571.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXT W/ CONTRAST", "code_information": [{"code": "73701", "type": "CPT"}, {"code": "2200033", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 810.9, "gross_charge": 901.0, "discounted_cash": 54.17, "estimated_discounted_cash": 901.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 232.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 720.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 810.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 513.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXT W/O CONTRAST", "code_information": [{"code": "73700", "type": "CPT"}, {"code": "2200010", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 180.59, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 180.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT NECK ST W/ CONT", "code_information": [{"code": "70491", "type": "CPT"}, {"code": "2200020", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 802.3, "gross_charge": 891.45, "discounted_cash": 54.17, "estimated_discounted_cash": 891.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 258.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 713.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 802.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 508.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT NECK ST W/O", "code_information": [{"code": "70490", "type": "CPT"}, {"code": "2200021", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 210.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT NECK ST W/WO CONTRAST", "code_information": [{"code": "70492", "type": "CPT"}, {"code": "2200019", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 889.21, "gross_charge": 988.02, "discounted_cash": 54.17, "estimated_discounted_cash": 988.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 311.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 790.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 889.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 563.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/EAR/FOSSA W/DYE", "code_information": [{"code": "70481", "type": "CPT"}], "standard_charges": [{"minimum": 191.87, "maximum": 251.56, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 251.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/EAR/FOSSA W/O&W/DYE", "code_information": [{"code": "70482", "type": "CPT"}], "standard_charges": [{"minimum": 191.87, "maximum": 295.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 295.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/SELLA/IAC", "code_information": [{"code": "70480", "type": "CPT"}, {"code": "2200012", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 221.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PELVIS W/ CONTRAST", "code_information": [{"code": "72193", "type": "CPT"}, {"code": "2200014", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 307.58, "maximum": 1008.55, "gross_charge": 891.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 307.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 713.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 802.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 508.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PELVIS W/O", "code_information": [{"code": "72192", "type": "CPT"}, {"code": "2200015", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 185.88, "maximum": 1008.55, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 185.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PELVIS W/WO", "code_information": [{"code": "72194", "type": "CPT"}, {"code": "2200013", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 311.88, "maximum": 1008.55, "gross_charge": 988.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 311.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 790.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 889.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 563.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PERFUSION W/CONTRAST CBF", "code_information": [{"code": "42T", "type": "CPT"}], "standard_charges": [{"minimum": 372.3, "maximum": 372.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 372.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT SCAN F/BIOMCHN CT ALYS", "code_information": [{"code": "558T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR LOCALIZATION", "code_information": [{"code": "77011", "type": "CPT"}], "standard_charges": [{"minimum": 296.96, "maximum": 301.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 301.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 296.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR NEEDLE BIOPSY", "code_information": [{"code": "77012", "type": "CPT"}], "standard_charges": [{"minimum": 193.88, "maximum": 296.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 193.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 296.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR THERAPY GUIDE", "code_information": [{"code": "77014", "type": "CPT"}], "standard_charges": [{"minimum": 296.96, "maximum": 296.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 296.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT SINUS W/O", "code_information": [{"code": "70486", "type": "CPT"}, {"code": "2200016", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 177.56, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 177.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SYRINGES CTP-200-FLS TRIPAK", "code_information": [{"code": "80000829", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 48.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CT THORACIC SPINE W/O", "code_information": [{"code": "72128", "type": "CPT"}, {"code": "2200017", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 181.02, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "estimated_discounted_cash": 520.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 181.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT THORAX LUNG CANCER SCR C-", "code_information": [{"code": "71271", "type": "CPT"}], "standard_charges": [{"minimum": 191.5, "maximum": 191.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 191.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT UPPER EXT W AND W/O", "code_information": [{"code": "73202", "type": "CPT"}, {"code": "2200039", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 728.1, "gross_charge": 809.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 311.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 647.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 728.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 461.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT UPPER EXT W/O", "code_information": [{"code": "73200", "type": "CPT"}, {"code": "2200018", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 468.66, "gross_charge": 520.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 416.59, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 468.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT UPPER EXT WITH CONTRAST", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "2200038", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 191.87, "maximum": 682.39, "gross_charge": 758.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 280.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 606.57, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 682.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 432.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT/CTA/MRI/A CHST FOLL REC", "code_information": [{"code": "G9554", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT/CTA/MRI/A NO FOLLUP IMAG", "code_information": [{"code": "G9556", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT/CTA/MRI/A NO THYR <1.0CM", "code_information": [{"code": "G9557", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT/MRI BRAIN DONE 24 HRS", "code_information": [{"code": "3112F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT/MRI BRAIN DONE W/IN 24HRS", "code_information": [{"code": "3111F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUBICIN 500MG/100ML 0.9% NS IVPB", "drug_information": {"unit": 500.0, "type": "EA"}, "code_information": [{"code": "J0878", "type": "HCPCS"}, {"code": "7000132", "type": "CDM"}, {"code": "71288001695", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 105.78, "maximum": 631.3, "gross_charge": 185.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 139.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 148.46, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 105.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUFF NIHON KOHDEN LG ADULT", "code_information": [{"code": "80000693", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CUL TYP ID BLD PTHGN 6+ TRGT", "code_information": [{"code": "87154", "type": "CPT"}], "standard_charges": [{"minimum": 250.77, "maximum": 250.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 250.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULT EPIDERM GRFT F/N/HFG +%", "code_information": [{"code": "15157", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT F/N/HF/G", "code_information": [{"code": "15155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT T/A/L +%", "code_information": [{"code": "15152", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT F/N/HFG ADD", "code_information": [{"code": "15156", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/A/L ADDL", "code_information": [{"code": "15151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/ARM/LEG", "code_information": [{"code": "15150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89250", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 1082.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1082.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89251", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 1125.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1125.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC IDENTIFY", "code_information": [{"code": "87077", "type": "CPT"}], "standard_charges": [{"minimum": 9.29, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE AFB", "code_information": [{"code": "87116", "type": "CPT"}, {"code": "1000131", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 12.42, "maximum": 87.73, "gross_charge": 63.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 51.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE ANAEROBE IDENT EACH", "code_information": [{"code": "87076", "type": "CPT"}], "standard_charges": [{"minimum": 9.29, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTERIA ANAEROBIC", "code_information": [{"code": "87073", "type": "CPT"}], "standard_charges": [{"minimum": 11.11, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTERIAL URINE", "code_information": [{"code": "P7001", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE BODY FLUID", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "1000076", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.91, "maximum": 45.87, "gross_charge": 50.97, "discounted_cash": 54.17, "estimated_discounted_cash": 50.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE CLOSTRIDIUM STOOL", "code_information": [{"code": "87075", "type": "CPT"}, {"code": "1000351", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.89, "maximum": 50.38, "gross_charge": 55.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 50.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE FUNGAL OTHER", "code_information": [{"code": "87102", "type": "CPT"}, {"code": "1000052", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.67, "maximum": 44.73, "gross_charge": 49.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 39.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 44.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 28.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE FUNGUS W/ STAIN", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "1000041", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 6.2, "maximum": 28.62, "gross_charge": 31.8, "discounted_cash": 54.17, "estimated_discounted_cash": 31.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 25.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 18.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE GENITAL", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "1000256", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.91, "maximum": 45.87, "gross_charge": 50.97, "discounted_cash": 54.17, "estimated_discounted_cash": 50.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE GONNORRHEA", "code_information": [{"code": "87081", "type": "CPT"}, {"code": "1000258", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.62, "maximum": 35.34, "gross_charge": 39.27, "discounted_cash": 54.17, "estimated_discounted_cash": 39.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE HERPES WITH TYPING", "code_information": [{"code": "87255", "type": "CPT"}, {"code": "1000507", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 38.94, "maximum": 180.38, "gross_charge": 200.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 160.34, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 180.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 114.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE HERPES WITHOUT TYPING", "code_information": [{"code": "87252", "type": "CPT"}, {"code": "1000261", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 29.98, "maximum": 89.96, "gross_charge": 99.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.96, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE LOWER RESIRATORY", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "1000356", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.91, "maximum": 45.87, "gross_charge": 50.97, "discounted_cash": 54.17, "estimated_discounted_cash": 50.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE OF SPECIMEN BY KIT", "code_information": [{"code": "87084", "type": "CPT"}], "standard_charges": [{"minimum": 23.08, "maximum": 31.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE STOOL", "code_information": [{"code": "87045", "type": "CPT"}, {"code": "1000117", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.86, "maximum": 50.24, "gross_charge": 55.83, "discounted_cash": 54.17, "estimated_discounted_cash": 238.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.66, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 50.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE IMMUNOFLUORESC", "code_information": [{"code": "87140", "type": "CPT"}], "standard_charges": [{"minimum": 6.41, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE IMMUNOLOGIC", "code_information": [{"code": "87147", "type": "CPT"}], "standard_charges": [{"minimum": 5.96, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE PULSE FIELD GEL", "code_information": [{"code": "87152", "type": "CPT"}], "standard_charges": [{"minimum": 8.9, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING ADDED METHOD", "code_information": [{"code": "87158", "type": "CPT"}], "standard_charges": [{"minimum": 8.9, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING GLC/HPLC", "code_information": [{"code": "87143", "type": "CPT"}], "standard_charges": [{"minimum": 14.4, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURE UPPER RESPIRATORY", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "1000257", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.91, "maximum": 45.87, "gross_charge": 50.97, "discounted_cash": 54.17, "estimated_discounted_cash": 50.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE VIRAL ROUTINE", "code_information": [{"code": "87252", "type": "CPT"}, {"code": "1000312", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 29.98, "maximum": 138.86, "gross_charge": 154.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 123.43, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 138.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE WOUND (AEROBIC) BACTERIAL", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "1000040", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.91, "maximum": 45.87, "gross_charge": 50.97, "discounted_cash": 54.17, "estimated_discounted_cash": 50.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURED CHONDROCYTES IMPLNT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CULTURELLE (NF-Culturelle) Dig. Health", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002616", "type": "CDM"}, {"code": "49100040021", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CUR FUNCT ASSES; NO CARE PLN", "code_information": [{"code": "G8543", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUR MEDS NOT DOCUMENT", "code_information": [{"code": "G8428", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65435", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65436", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CURRENT PERCEP THRESHOLD TST", "code_information": [{"code": "G0255", "type": "HCPCS"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CURRENT SMOKER", "code_information": [{"code": "G9642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CURRENT TOBACCO SMOKER", "code_information": [{"code": "1034F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM ABUTMENT", "code_information": [{"code": "D6057", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM FAB W/C BACK CUSHION", "code_information": [{"code": "E2617", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM FABRICATE W/C CUSHION", "code_information": [{"code": "E2609", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRAD GLOVE HEAVY", "code_information": [{"code": "S8426", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRAD GLOVE MED", "code_information": [{"code": "S8425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRAD SLEEVE HEAVY", "code_information": [{"code": "S8423", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRAD SLEEVE MED", "code_information": [{"code": "S8422", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRADIENT SLEEV/GLOV", "code_information": [{"code": "S8420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM ITEM", "code_information": [{"code": "S1002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM MOLD SHOE REMOV PROST", "code_information": [{"code": "L3250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM POWER WHLCHR BASE", "code_information": [{"code": "K0013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM SHOES DEPTH INLAY", "code_information": [{"code": "L3230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUTTING RAMUS OPEN W/GRAFT", "code_information": [{"code": "D7943", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CV CAROTID DOPPLER BILAT", "code_information": [{"code": "93880", "type": "CPT"}, {"code": "8000005", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 353.03, "maximum": 1314.06, "gross_charge": 1460.07, "discounted_cash": 54.17, "estimated_discounted_cash": 1460.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1095.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1168.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1314.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 832.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV CAROTID DOPPLER UNILAT", "code_information": [{"code": "93882", "type": "CPT"}, {"code": "8000009", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 264.6, "maximum": 417.79, "gross_charge": 464.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 348.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 371.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 417.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 264.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DOPPLER (COLOR FLOW)", "code_information": [{"code": "93325", "type": "CPT"}, {"code": "8000001", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 35.07, "maximum": 1480.98, "gross_charge": 61.53, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 49.22, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 55.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DOPPLER (PULSE WAVE)", "code_information": [{"code": "93320", "type": "CPT"}, {"code": "8000002", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 69.64, "maximum": 1480.98, "gross_charge": 122.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 91.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 109.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS ACS BLD ALG 5 YR SCORE", "code_information": [{"code": "415U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CV DS PLASMA ALYS PRTN BMRK", "code_information": [{"code": "19M", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CV DS QUAN ADVSRM/PLSM LPRTN", "code_information": [{"code": "377U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CV ECHO 2D", "code_information": [{"code": "93306", "type": "CPT"}, {"code": "8000003", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 832.23, "maximum": 1480.98, "gross_charge": 1460.07, "discounted_cash": 54.17, "estimated_discounted_cash": 1460.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1095.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1168.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1314.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 832.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV ECHO 2D LTD", "code_information": [{"code": "93304", "type": "CPT"}, {"code": "8000004", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 667.73, "maximum": 1480.98, "gross_charge": 1171.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 878.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 937.17, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1054.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 667.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV LOW EXT ART BILAT", "code_information": [{"code": "93925", "type": "CPT"}, {"code": "8000006", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 397.25, "maximum": 627.23, "gross_charge": 696.93, "discounted_cash": 54.17, "estimated_discounted_cash": 676.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 522.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 557.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 535.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 627.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 397.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV LOW EXT ART UNILAT", "code_information": [{"code": "93926", "type": "CPT"}, {"code": "8000012", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 195.72, "maximum": 535.94, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 257.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 535.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV LOW EXT VENOUS BILAT", "code_information": [{"code": "93970", "type": "CPT"}, {"code": "8000007", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 397.25, "maximum": 627.23, "gross_charge": 696.93, "discounted_cash": 54.17, "estimated_discounted_cash": 696.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 522.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 557.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 535.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 627.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 397.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV LOW EXT VENOUS UNILAT", "code_information": [{"code": "93971", "type": "CPT"}, {"code": "8000013", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 195.72, "maximum": 535.94, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 315.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 257.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 535.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV RENAL ARTERY DOPPLER", "code_information": [{"code": "93975", "type": "CPT"}, {"code": "8000018", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 353.03, "maximum": 1525.5, "gross_charge": 1695.0, "discounted_cash": 54.17, "estimated_discounted_cash": 1695.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1271.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1356.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1525.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 966.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV UPP EXT ART BILAT", "code_information": [{"code": "93930", "type": "CPT"}, {"code": "8000008", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 353.03, "maximum": 627.23, "gross_charge": 696.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 522.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 557.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 627.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 397.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV UPP EXT ART UNILAT", "code_information": [{"code": "93931", "type": "CPT"}, {"code": "8000016", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 195.72, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 257.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV UPP EXT VENOUS BILAT", "code_information": [{"code": "93970", "type": "CPT"}, {"code": "8000017", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 264.6, "maximum": 535.94, "gross_charge": 464.22, "discounted_cash": 54.17, "estimated_discounted_cash": 696.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 348.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 371.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 535.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 417.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 264.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV UPP EXT VENOUS UNILAT", "code_information": [{"code": "93971", "type": "CPT"}, {"code": "8000014", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 195.72, "maximum": 535.94, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 315.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 257.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 535.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CVA STROKE DX TX TRANSF FAC", "code_information": [{"code": "G9766", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CVD RISK ASSESS NOT PERF", "code_information": [{"code": "M1257", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CVD RISK ASSESS PERF", "code_information": [{"code": "M1258", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CXR DOC REV", "code_information": [{"code": "3006F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYCLER DIALYSIS MACHINE", "code_information": [{"code": "E1594", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYCLOPHOSPHAMIDE ORAL 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORA SMEAR", "code_information": [{"code": "87015", "type": "CPT"}, {"code": "1000933", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.68, "maximum": 35.58, "gross_charge": 39.54, "discounted_cash": 54.17, "estimated_discounted_cash": 39.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORIN", "code_information": [{"code": "80158", "type": "CPT"}, {"code": "1000121", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.76, "maximum": 96.17, "gross_charge": 106.86, "discounted_cash": 54.17, "estimated_discounted_cash": 106.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 96.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORIN PARENTERAL 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7516", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORINE ORAL 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORINE ORAL 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYGNUS DUAL PER SQ CM", "code_information": [{"code": "Q4282", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYGNUS MATRIX, PER SQ CM", "code_information": [{"code": "Q4199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYGNUS, PER SQ CM", "code_information": [{"code": "Q4170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYKLOKAPRON (TRANEXAMIC ACID)100MG/ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001145", "type": "CDM"}, {"code": "81284061110", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CYMBALTA (DULOXETINE) DR CAP 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001058", "type": "CDM"}, {"code": "57237001760", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 11.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CYMBALTA (DULOXETINE) DR CAP 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000233", "type": "CDM"}, {"code": "68180029506", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 14.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CYMBALTA (DULOXETINE) DR CAP 60MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000349", "type": "CDM"}, {"code": "68180029606", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 14.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CYMETRA INJECTABLE", "code_information": [{"code": "Q4112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP1A2 GENE", "code_information": [{"code": "31U", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2C19 GENE COM VARIANTS", "code_information": [{"code": "81225", "type": "CPT"}], "standard_charges": [{"minimum": 335.06, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 335.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2C9 GENE COM VARIANTS", "code_information": [{"code": "81227", "type": "CPT"}], "standard_charges": [{"minimum": 201.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2D6 3' GENE DUP/MLT", "code_information": [{"code": "76U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2D6 5' GENE DUP/MLT", "code_information": [{"code": "75U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2D6 FULL GENE SEQUENCE", "code_information": [{"code": "71U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN COM&SLCT RAR VRNT", "code_information": [{"code": "70U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D6-2D7 HYBRID", "code_information": [{"code": "72U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D7-2D6 HYBRID", "code_information": [{"code": "73U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GENE COM VARIANTS", "code_information": [{"code": "81226", "type": "CPT"}], "standard_charges": [{"minimum": 518.55, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 518.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP2D6 NONDUPLICATED GENE", "code_information": [{"code": "74U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP3A4 GENE COMMON VARIANTS", "code_information": [{"code": "81230", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 201.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP3A5 GENE COMMON VARIANTS", "code_information": [{"code": "81231", "type": "CPT"}], "standard_charges": [{"minimum": 201.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYS REN LES OR ADREN", "code_information": [{"code": "G9547", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTATIN C", "code_information": [{"code": "82610", "type": "CPT"}], "standard_charges": [{"minimum": 21.3, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO IMPL 4 OR MORE", "code_information": [{"code": "C9740", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO LASER TX URETERAL CALC", "code_information": [{"code": "S2070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO RX BALO CATH URTL STRX", "code_information": [{"code": "52284", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/ BX(S) W/ BLUE LIGHT", "code_information": [{"code": "C7550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/PRST8 COMMISSUROTOMY", "code_information": [{"code": "619T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/RENAL STRICTURE TX", "code_information": [{"code": "52343", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/UP STRICTURE TX", "code_information": [{"code": "52342", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/URETER STRICTURE TX", "code_information": [{"code": "52341", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO, LITHO, VACUUM KIDNEY", "code_information": [{"code": "C9761", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO STRICTURE TX", "code_information": [{"code": "52344", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/LITHOTRIPSY", "code_information": [{"code": "52356", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/UP STRICTURE", "code_information": [{"code": "52345", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/UP", "code_information": [{"code": "51727", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP", "code_information": [{"code": "51728", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP&UP", "code_information": [{"code": "51729", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY", "code_information": [{"code": "52000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & DUCT CATHETER", "code_information": [{"code": "52010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52275", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & URETER CATHETER", "code_information": [{"code": "52005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND BIOPSY", "code_information": [{"code": "52007", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND RADIOTRACER", "code_information": [{"code": "52250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52214", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52224", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52234", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52235", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52240", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52260", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52265", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52276", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52277", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52281", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52283", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52290", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52301", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52315", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52330", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52332", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY CHEMODENERVATION", "code_information": [{"code": "52287", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY IMPLANT STENT", "code_information": [{"code": "52282", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY INJECT MATERIAL", "code_information": [{"code": "52327", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY PROSTATIC IMP 1-3", "code_information": [{"code": "C9739", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY REMOVAL OF CLOTS", "code_information": [{"code": "52001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY STONE REMOVAL", "code_information": [{"code": "52325", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY W/BIOPSY(S)", "code_information": [{"code": "52204", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO & OR PYELOSCOPE", "code_information": [{"code": "52351", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/BIOPSY", "code_information": [{"code": "52354", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/CONGEN REPR", "code_information": [{"code": "52400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/EXCISE TUMOR", "code_information": [{"code": "52355", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/LITHOTRIPSY", "code_information": [{"code": "52353", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/RENAL STRICT", "code_information": [{"code": "52346", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/STONE REMOVE", "code_information": [{"code": "52352", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO CUT EJACUL DUCT", "code_information": [{"code": "52402", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO W/ADDL IMPLANT", "code_information": [{"code": "52442", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO W/IMPLANT", "code_information": [{"code": "52441", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTURETH BLU LI CYST FL IMG", "code_information": [{"code": "C7554", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTAL, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4166", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTARABINE HCL 100 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTARABINE LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9098", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTO/MOLECULAR REPORT", "code_information": [{"code": "88291", "type": "CPT"}], "standard_charges": [{"minimum": 36.65, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR CGH", "code_information": [{"code": "81228", "type": "CPT"}], "standard_charges": [{"minimum": 1035.0, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR LW-PS", "code_information": [{"code": "81349", "type": "CPT"}], "standard_charges": [{"minimum": 1357.2, "maximum": 1357.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1357.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR SNPCGH", "code_information": [{"code": "81229", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1334.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOG CONST ALYS INTERROG", "code_information": [{"code": "209U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOGEN TEST MARROW B/4 TX", "code_information": [{"code": "3155F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 10-30", "code_information": [{"code": "88273", "type": "CPT"}], "standard_charges": [{"minimum": 40.03, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 100-300", "code_information": [{"code": "88275", "type": "CPT"}], "standard_charges": [{"minimum": 58.87, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 25-99", "code_information": [{"code": "88274", "type": "CPT"}], "standard_charges": [{"minimum": 48.74, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 3-5", "code_information": [{"code": "88272", "type": "CPT"}], "standard_charges": [{"minimum": 46.81, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOGENOMIC NEO MICRORA ALYS", "code_information": [{"code": "81277", "type": "CPT"}], "standard_charges": [{"minimum": 1334.0, "maximum": 1334.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1334.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOMEG DNA AMP PROBE", "code_information": [{"code": "87496", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOMEG DNA DIR PROBE", "code_information": [{"code": "87495", "type": "CPT"}], "standard_charges": [{"minimum": 34.53, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS AG IA", "code_information": [{"code": "87332", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS DFA", "code_information": [{"code": "87271", "type": "CPT"}], "standard_charges": [{"minimum": 15.43, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS IGG", "code_information": [{"code": "86644", "type": "CPT"}, {"code": "1000636", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.55, "maximum": 96.7, "gross_charge": 85.2, "discounted_cash": 54.17, "estimated_discounted_cash": 85.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 76.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS IGM", "code_information": [{"code": "86645", "type": "CPT"}, {"code": "1000078", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.38, "maximum": 96.7, "gross_charge": 99.72, "discounted_cash": 54.17, "estimated_discounted_cash": 99.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS IMM IV /VIAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0850", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOMEL 25MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003404", "type": "CDM"}, {"code": "42794001912", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO FLUID REDO", "code_information": [{"code": "88175", "type": "CPT"}], "standard_charges": [{"minimum": 30.6, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO IN FLUID", "code_information": [{"code": "88174", "type": "CPT"}], "standard_charges": [{"minimum": 29.18, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO REDO", "code_information": [{"code": "88152", "type": "CPT"}], "standard_charges": [{"minimum": 31.79, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO RESCREEN", "code_information": [{"code": "88148", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTOMATED", "code_information": [{"code": "88147", "type": "CPT"}], "standard_charges": [{"minimum": 55.12, "maximum": 58.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V INDEX ADD-ON", "code_information": [{"code": "88155", "type": "CPT"}], "standard_charges": [{"minimum": 16.85, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V INTERPRET", "code_information": [{"code": "88141", "type": "CPT"}], "standard_charges": [{"minimum": 24.14, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V REDO", "code_information": [{"code": "88153", "type": "CPT"}], "standard_charges": [{"minimum": 27.63, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V THIN LAYER", "code_information": [{"code": "88142", "type": "CPT"}], "standard_charges": [{"minimum": 23.3, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V THIN LAYER REDO", "code_information": [{"code": "88143", "type": "CPT"}], "standard_charges": [{"minimum": 26.5, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH EVAL FNA REPORT", "code_information": [{"code": "88173", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 169.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 169.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH FL NONGYN FILTER", "code_information": [{"code": "88106", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 71.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 71.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH REPORT NON ROUTINE", "code_information": [{"code": "551F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH REPORT NONGYN SPCMN", "code_information": [{"code": "550F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEAR OTHER SOURCE", "code_information": [{"code": "88160", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 76.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 76.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEAR OTHER SOURCE", "code_information": [{"code": "88162", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 121.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 121.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEAR PREP & REPORT", "code_information": [{"code": "D0480", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V AUTO REDO", "code_information": [{"code": "88166", "type": "CPT"}], "standard_charges": [{"minimum": 18.31, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V MANUAL", "code_information": [{"code": "88164", "type": "CPT"}], "standard_charges": [{"minimum": 18.31, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V REDO", "code_information": [{"code": "88165", "type": "CPT"}], "standard_charges": [{"minimum": 48.55, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V SELECT", "code_information": [{"code": "88167", "type": "CPT"}], "standard_charges": [{"minimum": 18.31, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOTOXIC ANTIBODY SCREENING", "code_information": [{"code": "86807", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 90.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTOTOXIC ANTIBODY SCREENING", "code_information": [{"code": "86808", "type": "CPT"}], "standard_charges": [{"minimum": 34.13, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTP DX EVAL FNA 1ST EA SITE", "code_information": [{"code": "88172", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 59.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTP FNA EVAL EA ADDL", "code_information": [{"code": "88177", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 31.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTP URINE 3-5 PROBES CMPTR", "code_information": [{"code": "88121", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 457.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 457.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYTP URNE 3-5 PROBES EA SPEC", "code_information": [{"code": "88120", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 649.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 649.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Calcium acetate, oral, 23 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cannulation of the liver allograft in preparation for connection to the normothermic perfusion device and decannulation of the liver allograft following normothermic perfusion", "code_information": [{"code": "894T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cantharidin top, applicator", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Capecitabine, oral, 50 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8522", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Carbonic anhydrase VI (CA VI), parotid specific/secretory protein (PSP) and salivary protein (SP1) IgG, IgM, and IgA antibodies, enzyme-linked immunosorbent assay (ELISA), semiqualitative, blood, reported as predictive evidence of early Sj\u00f6gren's syndrome", "code_information": [{"code": "472U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Carbonic anhydrase VI, parotid specific/secretory protein and salivary protein 1 (SP1), IgG, IgM, and IgA antibodies, chemiluminescence, semiqualitative, blood", "code_information": [{"code": "522U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiology (coronary artery disease [CAD]), DNA, genome-wide association studies (564856 single-nucleotide polymorphisms [SNPs], targeted variant genotyping), patient lifestyle and clinical data, buccal swab, algorithm reported as polygenic risk to acquir", "code_information": [{"code": "466U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiology (coronary heart disease [CHD]), DNA, analysis of 10 single-nucleotide polymorphisms (SNPs) (rs710987 [LINC010019], rs1333048 [CDKN2B-AS1], rs12129789 [KCND3], rs942317 [KTN1-AS1], rs1441433 [PPP3CA], rs2869675 [PREX1], rs4639796 [ZBTB41], rs437", "code_information": [{"code": "440U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiology (coronary heart disease [CHD]), DNA, analysis of 5 single-nucleotide polymorphisms (SNPs) (rs11716050 [LOC105376934], rs6560711 [WDR37], rs3735222 [SCIN/LOC107986769], rs6820447 [intergenic], and rs9638144 [ESYT2]) and 3 DNA methylation markers", "code_information": [{"code": "439U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiovascular disease (HDL reverse cholesterol transport), cholesterol efflux capacity, LC-MS/MS, quantitative measurement of 5 distinct HDL-bound apolipoproteins (apolipoproteins A1, C1, C2, C3, and C4), serum, algorithm reported as prediction of corona", "code_information": [{"code": "541U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 m", "code_information": [{"code": "G0539", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face", "code_information": [{"code": "G0540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infe", "code_information": [{"code": "G0541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infe", "code_information": [{"code": "G0542", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CaregraFT, per square centimeter", "code_information": [{"code": "Q4322", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Carrier screening for severe inherited conditions (eg, cystic fibrosis, spinal muscular atrophy, beta hemoglobinopathies [including sickle cell disease], alpha thalassemia), regardless of race or self-identified ancestry, genomic sequence analysis panel, ", "code_information": [{"code": "449U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) fo", "code_information": [{"code": "C7562", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Catheter(s), intravascular for renal denervation, radiofrequency, including all single use system components", "code_information": [{"code": "C1735", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Catheter(s), intravascular for renal denervation, ultrasound, including all single use system components", "code_information": [{"code": "C1736", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Catheter, transluminal drug delivery with or without angioplasty, coronary, non-laser (insertable)", "code_information": [{"code": "C9610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Catheterization with removal of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate", "code_information": [{"code": "53866", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CellCept (MYCOPHENOLATE) 500MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7517", "type": "HCPCS"}, {"code": "7002661", "type": "CDM"}, {"code": "64380072506", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 3.42, "maximum": 5.4, "gross_charge": 6.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 5.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "code_information": [{"code": "L0720", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Chikungunya virus vaccine, recombinant, for intramuscular use", "code_information": [{"code": "90593", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous", "code_information": [{"code": "38228", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day", "code_information": [{"code": "38225", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (eg, cryopreservation, storage)", "code_information": [{"code": "38226", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration", "code_information": [{"code": "38227", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ChoriPly, per square centimeter", "code_information": [{"code": "Q4359", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Closed Tx interphalangeal joint w/o ANEN", "code_information": [{"code": "26770", "type": "CPT"}, {"code": "12300321", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 563.29, "maximum": 1417.85, "gross_charge": 988.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 741.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 790.58, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 889.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 563.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ColBenemid (Proben/Colch) 500MG/0.5MG Ta", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003072", "type": "CDM"}, {"code": "50742026301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.12, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Colonoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed", "code_information": [{"code": "885T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Combigan Ophth Soln 0.2%-0.5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003993", "type": "CDM"}, {"code": "00832142505", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 60.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Complete ophthalmologic care MIPS value pathway", "code_information": [{"code": "M1420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; retina, including OCT angiography", "code_information": [{"code": "92137", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Concurrent optical and magnetic stimulation (COMS) therapy, wound assessment and dressing care; each additional application, total wound(s) surface area less than or equal to 50 sq cm (List separately in addition to code for primary procedure)", "code_information": [{"code": "907T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Concurrent optical and magnetic stimulation (COMS) therapy, wound assessment and dressing care; first application, total wound(s) surface area less than or equal to 50 sq cm", "code_information": [{"code": "906T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Connection of liver allograft to normothermic machine perfusion device, hemostasis control; each additional hour, including physiological and laboratory assessments (eg, perfusate temperature, perfusate pH, hemodynamic parameters, bile production, bile pH", "code_information": [{"code": "896T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Connection of liver allograft to normothermic machine perfusion device, hemostasis control; initial 4 hours of monitoring time, including hourly physiological and laboratory assessments (eg, perfusate temperature, perfusate pH, hemodynamic parameters, bil", "code_information": [{"code": "895T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, whic", "code_information": [{"code": "G0534", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Corplex P or Theracor P or Allacor P, per milligram", "code_information": [{"code": "A2035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cryoablation needle (e.g., iovera system), including needle/tip and all disposable system components, non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the C", "code_information": [{"code": "C9809", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cryotherapy of the oral cavity using temperature regulated fluid cooling system, including placement of an oral device, monitoring of patient tolerance to treatment, and removal of the oral device", "code_information": [{"code": "881T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Currently on first-line immune checkpoint inhibitors without chemotherapy", "code_information": [{"code": "M1411", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cygnus Disk, per square centimeter", "code_information": [{"code": "Q4362", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy with insertion of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate", "code_information": [{"code": "53865", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteral approach, including insertion of guide wire, selective placement of ureteral sheath(s) and multiple conformable electrodes, contrast injection(s), an", "code_information": [{"code": "935T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy, flexible; with insertion and expansion of prostatic urethral scaffold using integrated cystoscopic visualization", "code_information": [{"code": "941T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy, flexible; with removal and replacement of prostatic urethral scaffold", "code_information": [{"code": "942T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy, flexible; with removal of prostatic urethral scaffold", "code_information": [{"code": "943T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cytogenomic (genome-wide) analysis, hematologic malignancy, structural variants and copy number variants, optical genome mapping (OGM)", "code_information": [{"code": "81195", "type": "CPT"}], "standard_charges": [{"minimum": 1453.06, "maximum": 1453.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1453.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "D & C AFTER DELIVERY", "code_information": [{"code": "59160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "D DIMER", "code_information": [{"code": "85379", "type": "CPT"}, {"code": "1000219", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.71, "maximum": 57.79, "gross_charge": 60.21, "discounted_cash": 54.17, "estimated_discounted_cash": 60.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "D&C OF CERVICAL STUMP", "code_information": [{"code": "57558", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC", "code_information": [{"code": "744", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC", "code_information": [{"code": "745", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "D/C", "code_information": [{"code": "3000122", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "D/C", "code_information": [{"code": "3000123", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "D/C", "code_information": [{"code": "3000468", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "D5W/0.45NS W KCL AND MGS04", "code_information": [{"code": "S5014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DACARBAZINE 100 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DACLIZUMAB, PARENTERAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7513", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DACTINOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9120", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAILY CONT LENS", "code_information": [{"code": "S0512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAILY DESL CALENDAR BASE", "code_information": [{"code": "80000905", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 7.32, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DAKIN'S SOLUTION 0.125%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000813", "type": "CDM"}, {"code": "00436093616", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DALIRESP (ROFLUMILAST) 500MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001049", "type": "CDM"}, {"code": "00310009530", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DALTEPARIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1645", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAPRODUSTAT ORAL 1MG ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0889", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DARATUMUMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9144", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DARBEPOETIN ALFA, ESRD USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0882", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DARBEPOETIN ALFA, NON-ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0881", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87164", "type": "CPT"}], "standard_charges": [{"minimum": 12.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87166", "type": "CPT"}], "standard_charges": [{"minimum": 13.0, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAUNORUBICIN CITRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9151", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAUNORUBICIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9150", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAY HABIL WAIVER PER 15 MIN", "code_information": [{"code": "T2021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAY HABIL WAIVER PER DIEM", "code_information": [{"code": "T2020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT BONE 1ST 20 SQ CM/<", "code_information": [{"code": "11044", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT BONE EACH ADDL", "code_information": [{"code": "11047", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT ECZ/INFCT SKN EA ADDL", "code_information": [{"code": "11001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT MUSC&/FSCA 1ST 20/<", "code_information": [{"code": "11043", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT MUSC&/FSCA EA ADDL", "code_information": [{"code": "11046", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT OPN WND ADDL 20CM/<", "code_information": [{"code": "97598", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT PRMLG LES W/PDT", "code_information": [{"code": "96574", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN ABDOMINAL WALL", "code_information": [{"code": "11005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT PER", "code_information": [{"code": "11006", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT&PER", "code_information": [{"code": "11004", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TIS 1ST 20SQCM/<", "code_information": [{"code": "11042", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TISS EACH ADDL", "code_information": [{"code": "11045", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DC EOC DOC MED REC", "code_information": [{"code": "M1013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DC EPI CARE DOC MEDREC", "code_information": [{"code": "M1014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DC POWER ADAPTER, PORT CONC", "code_information": [{"code": "E1358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DCMPRN PX PERQ 1/MLT LUMBAR", "code_information": [{"code": "62287", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DDAVP (DESMOPRESSIN) 0.2MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001111", "type": "CDM"}, {"code": "23155049001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DE LEE MUCUS TRAP 6.5FR", "code_information": [{"code": "3001178", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEB BONE 20 CM2 W/DRUG DEV", "code_information": [{"code": "C7500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEB SKIN BONE AT FX SITE", "code_information": [{"code": "11012", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "11721", "type": "CPT"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN AT FX SITE", "code_information": [{"code": "11010", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN MUSC AT FX SITE", "code_information": [{"code": "11011", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT & CONTOURING", "code_information": [{"code": "D6102", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT 20CM OR LESS", "code_information": [{"code": "97597", "type": "CPT"}, {"code": "11000287", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF A PERIIMPLANT", "code_information": [{"code": "D6101", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR I", "code_information": [{"code": "11000", "type": "CPT"}, {"code": "11000297", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF NAIL TECH", "code_information": [{"code": "11720", "type": "CPT"}, {"code": "11000034", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 122.33, "maximum": 209.42, "gross_charge": 214.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 160.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 171.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 193.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 122.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRISAN WOUND PASTE", "code_information": [{"code": "3000158", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DECADRON (DEXAMETH) 10MG INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J1100", "type": "HCPCS"}, {"code": "72000560", "type": "CDM"}, {"code": "00641036725", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 9.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECADRON (DEXAMETH) 4MG INJ", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J1100", "type": "HCPCS"}, {"code": "72000968", "type": "CDM"}, {"code": "67457042312", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 9.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECADRON (DEXAMETHASONE) 0.75MG TAB", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J8540", "type": "HCPCS"}, {"code": "72001070", "type": "CDM"}, {"code": "00054818025", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECADRON (DEXAMETHASONE) 1MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8540", "type": "HCPCS"}, {"code": "7003842", "type": "CDM"}, {"code": "00054418125", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECADRON TAB 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8540", "type": "HCPCS"}, {"code": "72000263", "type": "CDM"}, {"code": "00054418425", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECALCIFICATION PROCEDURE", "code_information": [{"code": "D0475", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECALCIFY TISSUE", "code_information": [{"code": "88311", "type": "CPT"}], "standard_charges": [{"minimum": 22.65, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECITABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0894", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECLOGGER BLUE G OR J TUBE", "code_information": [{"code": "3001373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DECLOGGER ORANGE G OR J TUBE", "code_information": [{"code": "3001374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DECLOT VASCULAR DEVICE", "code_information": [{"code": "36593", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS DISC RF LUMBAR", "code_information": [{"code": "S2348", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS EYE SOCKET", "code_information": [{"code": "61330", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26035", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26037", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25023", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25024", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25025", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS OPTIC NERVE", "code_information": [{"code": "67570", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SMALL BOWEL", "code_information": [{"code": "44021", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD LMBR", "code_information": [{"code": "63056", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63055", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63064", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63057", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63066", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF FOREARM", "code_information": [{"code": "24495", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27892", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27893", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27894", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27601", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27602", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27496", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27497", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27498", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27499", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF TIBIA NERVE", "code_information": [{"code": "28035", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE CRANIOTOMY", "code_information": [{"code": "61322", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE LOBECTOMY", "code_information": [{"code": "61323", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOR OR SUBMERG ERUPT TOOTH", "code_information": [{"code": "D3921", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEEP ANEST, 1ST 15 MIN", "code_information": [{"code": "D9222", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.72, "maximum": 112.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEEP MUSCLE BIOPSY", "code_information": [{"code": "20205", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEFEROXAMINE MESYLATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0895", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEFIB GEL PAD 9X4-1/2", "code_information": [{"code": "3001440", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 19.47, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEFIB GEL PAD 9X6", "code_information": [{"code": "3000160", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEFIBRILLATION", "code_information": [{"code": "92960", "type": "CPT"}, {"code": "11000226", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 876.64, "maximum": 2061.93, "gross_charge": 1537.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1153.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1230.38, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2061.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1384.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 876.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEGARELIX INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9155", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.3, "maximum": 631.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "56", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [{"code": "57", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTERONE", "code_information": [{"code": "82626", "type": "CPT"}], "standard_charges": [{"minimum": 29.06, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTERONE-SULFATE", "code_information": [{"code": "82627", "type": "CPT"}, {"code": "1000366", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 25.56, "maximum": 118.44, "gross_charge": 131.61, "discounted_cash": 54.17, "estimated_discounted_cash": 131.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 105.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 118.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 75.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEIONIZER H2O PURI SYSTEM", "code_information": [{"code": "E1615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP ARMS/LEGS", "code_information": [{"code": "15610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP EYE/NOS/EAR/LIP", "code_information": [{"code": "15630", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP F/C/C/N/AX/G/H/F", "code_information": [{"code": "15620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP TRUNK", "code_information": [{"code": "15600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELI/INSTALL CHRG HEMO EQUIP", "code_information": [{"code": "E1600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELIVER PLACENTA", "code_information": [{"code": "59414", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELIVERY COMP IMRT", "code_information": [{"code": "G6016", "type": "HCPCS"}], "standard_charges": [{"minimum": 611.27, "maximum": 611.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 611.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELIVERY/SET UP/DISPENSING", "code_information": [{"code": "A9901", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELSYM (NF-DELSYM) SUSP ER 30MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000985", "type": "CDM"}, {"code": "63824017165", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DELUXE ITEM", "code_information": [{"code": "S1001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELUXE LENS FEATURE", "code_information": [{"code": "V2702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELUXE SLING & SWATHE SM", "code_information": [{"code": "3001129", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 30.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEM SEVERITY CLASS SEVERE", "code_information": [{"code": "1493F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEM SEVERITY CLASSIFIED MILD", "code_information": [{"code": "1490F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEM SEVERITY CLASSIFIED MOD", "code_information": [{"code": "1491F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEMADEX (TORSEMIDE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000405", "type": "CDM"}, {"code": "50268075715", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEMADEX (TORSEMIDE) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000222", "type": "CDM"}, {"code": "00904728306", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEMADEX (TORSEMIDE) TAB. 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001008", "type": "CDM"}, {"code": "50268075415", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEMO-SMOKING CESSATION COUN", "code_information": [{"code": "G9016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEMONSTRATE USE HOME INR MON", "code_information": [{"code": "G0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENERVATION OF HIP JOINT", "code_information": [{"code": "27035", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 2 DOSE SUBQ", "code_information": [{"code": "90584", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 3 DOSE SUBQ", "code_information": [{"code": "90587", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENOSUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0897", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENT ANESTHESIA W/O SURGERY", "code_information": [{"code": "D9210", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.72, "maximum": 112.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENT APPL DESENSITIZING MED", "code_information": [{"code": "D9910", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENT CASE MGMT SPECIAL NEEDS", "code_information": [{"code": "D9997", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENT SUTUR RECENT WND TO 5CM", "code_information": [{"code": "D7910", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENT THERAPEUTIC DRUG INJECT", "code_information": [{"code": "D9610", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [{"code": "158", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [{"code": "157", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITHOUT CC/MCC", "code_information": [{"code": "159", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DENTAL BITEWING SINGLE IMAGE", "code_information": [{"code": "D0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL BITEWINGS TWO IMAGES", "code_information": [{"code": "D0272", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL CONNECTOR BAR", "code_information": [{"code": "D6920", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL CONSULTATION", "code_information": [{"code": "D9310", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL CORONOIDECTOMY", "code_information": [{"code": "D7991", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL GOLD FOIL ONE SURFACE", "code_information": [{"code": "D2410", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL GOLD FOIL THREE SURFA", "code_information": [{"code": "D2430", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL GOLD FOIL TWO SURFACE", "code_information": [{"code": "D2420", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL HOUSE CALL", "code_information": [{"code": "D9410", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL INLAY METALIC 1 SURF", "code_information": [{"code": "D2510", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL INLAY METALLIC 2 SURF", "code_information": [{"code": "D2520", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL INLAY METL 3/MORE SUR", "code_information": [{"code": "D2530", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL INLAY RESIN 3/MRE SUR", "code_information": [{"code": "D2652", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METALLIC 2 SURF", "code_information": [{"code": "D2542", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METALLIC 3 SURF", "code_information": [{"code": "D2543", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METL 4/MORE SUR", "code_information": [{"code": "D2544", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORC 3/MORE SUR", "code_information": [{"code": "D2630", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORC 4/MORE SUR", "code_information": [{"code": "D2644", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORCELIN 2 SURF", "code_information": [{"code": "D2642", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORCELIN 3 SURF", "code_information": [{"code": "D2643", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 2 SURFACE", "code_information": [{"code": "D2662", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 3 SURFACE", "code_information": [{"code": "D2663", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 4/MRE SUR", "code_information": [{"code": "D2664", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL PROPHYLAXIS ADULT", "code_information": [{"code": "D1110", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL PROPHYLAXIS CHILD", "code_information": [{"code": "D1120", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL RETAINR CAST METL", "code_information": [{"code": "D6545", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL SALIOGRAPHY", "code_information": [{"code": "D0310", "type": "HCPCS"}], "standard_charges": [{"minimum": 377.64, "maximum": 377.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 377.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL SEALANT PER TOOTH", "code_information": [{"code": "D1351", "type": "HCPCS"}], "standard_charges": [{"minimum": 133.32, "maximum": 133.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 133.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL SKIN GRAFT", "code_information": [{"code": "D7920", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL SUTURE WOUND TO 5 CM", "code_information": [{"code": "D7911", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL TMJ ARTHROGRAM INCL I", "code_information": [{"code": "D0320", "type": "HCPCS"}], "standard_charges": [{"minimum": 377.64, "maximum": 377.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 377.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL TOMOGRAPHIC SURVEY", "code_information": [{"code": "D0322", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTAL UNSPEC RESTORATIVE PR", "code_information": [{"code": "D2999", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTISTRY SS", "code_information": [{"code": "G0067", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE CUP", "code_information": [{"code": "3000014", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DENTURE INTERM CMPLT MANDBL", "code_information": [{"code": "D5811", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM CMPLT MAXILL", "code_information": [{"code": "D5810", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM PART MANDBL", "code_information": [{"code": "D5821", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM PART MAXILL", "code_information": [{"code": "D5820", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAND DIR", "code_information": [{"code": "D5731", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAND IND", "code_information": [{"code": "D5751", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAX DIR", "code_information": [{"code": "D5730", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAX INDIR", "code_information": [{"code": "D5750", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAND DIR", "code_information": [{"code": "D5741", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAND INDIR", "code_information": [{"code": "D5761", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAX DIR", "code_information": [{"code": "D5740", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAX INDIR", "code_information": [{"code": "D5760", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE TISS CONDITN MAXILL", "code_information": [{"code": "D5850", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURE TISS CONDTIN MANDBL", "code_information": [{"code": "D5851", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST CMPLT MAND", "code_information": [{"code": "D5411", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST CMPLT MAXIL", "code_information": [{"code": "D5410", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST PART MANDBL", "code_information": [{"code": "D5422", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST PART MAXILL", "code_information": [{"code": "D5421", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES COMPLETE MANDIBLE", "code_information": [{"code": "D5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES COMPLETE MAXILLARY", "code_information": [{"code": "D5110", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES IMMEDIAT MANDIBLE", "code_information": [{"code": "D5140", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES IMMEDIAT MAXILLARY", "code_information": [{"code": "D5130", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES MAND PART RESIN", "code_information": [{"code": "D5212", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES MANDIBL PART METAL", "code_information": [{"code": "D5214", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES MAXILL PART METAL", "code_information": [{"code": "D5213", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES MAXILL PART RESIN", "code_information": [{"code": "D5211", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE CMPLT MAND", "code_information": [{"code": "D5711", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE CMPLT MAXIL", "code_information": [{"code": "D5710", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE PART MANDBL", "code_information": [{"code": "D5721", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE PART MAXILL", "code_information": [{"code": "D5720", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEODORANT", "code_information": [{"code": "3000015", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEOXYCORTISOL", "code_information": [{"code": "82634", "type": "CPT"}], "standard_charges": [{"minimum": 33.67, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEOXYRIBONUCLEASE ANTIBODY", "code_information": [{"code": "86215", "type": "CPT"}], "standard_charges": [{"minimum": 15.24, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEP SCR NOT DOC, RNG", "code_information": [{"code": "G8432", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEPACON (VALPORATE SOD) 500MG IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200073", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 46.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEPAKOTE (DIVALPROEX SOD) DR 500MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003359", "type": "CDM"}, {"code": "00832712401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEPAKOTE (divalporic acid) LIQ 250MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000376", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEPAKOTE ER (DIVALPROEX SOD) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000140", "type": "CDM"}, {"code": "65162075510", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEPAKOTE ER TABLET 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001027", "type": "CDM"}, {"code": "65162075710", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEPAKOTE SPRINKLES CAP 125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000607", "type": "CDM"}, {"code": "68382010601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEPO MEDROL 40MG INJ", "drug_information": {"unit": 40.0, "type": "EA"}, "code_information": [{"code": "J1010", "type": "HCPCS"}, {"code": "7000143", "type": "CDM"}, {"code": "00009307303", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPO MEDROL 80MG INJ", "drug_information": {"unit": 80.0, "type": "EA"}, "code_information": [{"code": "J1010", "type": "HCPCS"}, {"code": "72000470", "type": "CDM"}, {"code": "00009347503", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPO-ESTRADIOL CYPIONATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEPRESSION SCREEN ANNUAL", "code_information": [{"code": "G0444", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.86, "maximum": 76.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEPRESSIVE NEUROSES", "code_information": [{"code": "881", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT F/N/HF/G ADD", "code_information": [{"code": "15136", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT FACE/NCK/HF/G", "code_information": [{"code": "15135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT T/A/L ADD-ON", "code_information": [{"code": "15131", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT TRNK/ARM/LEG", "code_information": [{"code": "15130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERM-MAXX, PER SQ CM", "code_information": [{"code": "Q4238", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMA-BLUE DRESS 4X4", "code_information": [{"code": "3001462", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMA-FAT-FASCIA GRAFT", "code_information": [{"code": "15770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMA-GEL DRESS 4X4", "code_information": [{"code": "3001124", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMA-GIDE, 1 SQ CM", "code_information": [{"code": "Q4203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABIND CH, PER SQ CM", "code_information": [{"code": "Q4288", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABIND DL, PER SQ CM", "code_information": [{"code": "Q4287", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABIND SL, PER SQ CM", "code_information": [{"code": "Q4284", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABOND", "code_information": [{"code": "3000164", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 80.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMABRASION OTHER THAN FACE", "code_information": [{"code": "15782", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SEGMENTAL FACE", "code_information": [{"code": "15781", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SUPRFL ANY SITE", "code_information": [{"code": "15783", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABRASION TOTAL FACE", "code_information": [{"code": "15780", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMACELL, AWM, POROUS SQ CM", "code_information": [{"code": "Q4122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMACERIN MOISTURE CRM", "code_information": [{"code": "3001325", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMACYTE AMN MEM ALLO SQ CM", "code_information": [{"code": "Q4248", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMAGAUZE HYDROGEL DRESS. 4X4", "code_information": [{"code": "3001331", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMAGINATE 4X4 DRSG", "code_information": [{"code": "3000483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMAGINATE DRESS 4X8", "code_information": [{"code": "3001341", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMAGRAFT", "code_information": [{"code": "Q4106", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMAL FILLER INJECTION(S)", "code_information": [{"code": "G0429", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMAPURE 1 SQUARE CM", "code_information": [{"code": "Q4152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMASEPTIN OINTMENT 4OZ TUBE", "code_information": [{"code": "3001324", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMATOLOGY SS", "code_information": [{"code": "G4000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMAVEST, PLURIVEST SQ CM", "code_information": [{"code": "Q4153", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMEL GEL WOUND CAR", "code_information": [{"code": "3000165", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DERMEL SPRAY CLEANSE", "code_information": [{"code": "3000166", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DESIGN CUSTOM BREAST IMPLANT", "code_information": [{"code": "19396", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESIGN MLC DEVICE FOR IMRT", "code_information": [{"code": "77338", "type": "CPT"}], "standard_charges": [{"minimum": 584.0, "maximum": 749.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 749.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESITIN OINTMENT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000144", "type": "CDM"}, {"code": "74300000300", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 10.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DESOXYCORTICOSTERONE", "code_information": [{"code": "82633", "type": "CPT"}], "standard_charges": [{"minimum": 35.63, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 35.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY C/TH FACET JNT ADDL", "code_information": [{"code": "64634", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY CERV/THOR FACET JNT", "code_information": [{"code": "64633", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY INTERNAL HEMORRHOIDS", "code_information": [{"code": "46930", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY L/S FACET JNT ADDL", "code_information": [{"code": "64636", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY LUMB/SAC FACET JNT", "code_information": [{"code": "64635", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE FACE MUSCLE", "code_information": [{"code": "64612", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE OF EYE MUSCLE", "code_information": [{"code": "67345", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY PREMAL LESIONS 15/>", "code_information": [{"code": "17004", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS COMPLEX", "code_information": [{"code": "57065", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS SIMPLE", "code_information": [{"code": "57061", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESION/S COMPL", "code_information": [{"code": "56515", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESIONS SIM", "code_information": [{"code": "56501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCT B9 LESION 1-14", "code_information": [{"code": "17110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCT LESION 15 OR MORE", "code_information": [{"code": "17111", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LES 2-14", "code_information": [{"code": "17003", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LESION", "code_information": [{"code": "17000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46910", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46924", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66700", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66720", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66740", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17106", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17107", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17108", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54050", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54055", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54065", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION RECTAL TUMOR", "code_information": [{"code": "45190", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DETECT AGENT NOS DNA DIR", "code_information": [{"code": "87797", "type": "CPT"}], "standard_charges": [{"minimum": 34.53, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DETECT AGNT MULT DNA DIREC", "code_information": [{"code": "87800", "type": "CPT"}], "standard_charges": [{"minimum": 23.08, "maximum": 50.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DETERMINE REFRACTIVE STATE", "code_information": [{"code": "92015", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DETROL LA (TOLTERODINE TART) CAP 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000254", "type": "CDM"}, {"code": "00093716356", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 14.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DETROL LA CAP 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000489", "type": "CDM"}, {"code": "51079019803", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEV DELAY PREV DP CH, 15 MIN", "code_information": [{"code": "H2037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEV INTERROG REMOTE 1/2/MLT", "code_information": [{"code": "93295", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEVEL TST 1ST HR", "code_information": [{"code": "96112", "type": "CPT"}, {"code": "81000517", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"minimum": 230.91, "maximum": 364.6, "gross_charge": 405.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 303.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 324.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 364.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 230.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST EA ADDL", "code_information": [{"code": "96113", "type": "CPT"}, {"code": "81000528", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"minimum": 107.23, "maximum": 169.31, "gross_charge": 188.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 141.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 150.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 169.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 107.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVELOPMENTAL SCREEN W/SCORE", "code_information": [{"code": "96110", "type": "CPT"}], "standard_charges": [{"minimum": 1848.13, "maximum": 1848.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1848.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEVICE HANDLING PHYS/QHP", "code_information": [{"code": "99002", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEVISE BOWEL POUCH", "code_information": [{"code": "44316", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEVLOPMENT TEST INTERPT&REP", "code_information": [{"code": "G0451", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEX 0.2% NACL 500 5%", "code_information": [{"code": "3001038", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEXAMETHA OPTH INSERT 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1096", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7638", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE INTRA IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7312", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE PANEL", "code_information": [{"code": "80420", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 186.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 186.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXFERRUM (IRON DEXTRAN) 50MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1750", "type": "HCPCS"}, {"code": "7000146", "type": "CDM"}, {"code": "00517234010", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.45, "maximum": 267.21, "gross_charge": 21.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXILANT (DEXLANSOPRAZOLE DR) 60MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004391", "type": "CDM"}, {"code": "00378208693", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DEXMEDETOMIDINE FILM, 1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXRAZOXANE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1190", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXTRAN 40 INFUSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXTRAN 75 INFUSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXTRANOMER/HYALURONIC ACID", "code_information": [{"code": "L8604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXTROAMPHETAMINE", "code_information": [{"code": "S0160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXTROSE 5% 250ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7060", "type": "HCPCS"}, {"code": "7200006", "type": "CDM"}, {"code": "00338001702", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 5.27, "maximum": 8.32, "gross_charge": 9.25, "discounted_cash": 54.17, "estimated_discounted_cash": 23.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 5.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXTROSE 5% WATER 1000ML", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J7060", "type": "HCPCS"}, {"code": "7200010", "type": "CDM"}, {"code": "00338001704", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.73, "maximum": 10.62, "gross_charge": 11.81, "discounted_cash": 54.17, "estimated_discounted_cash": 23.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXTROSE 5%/0.45% NS 1000ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7042", "type": "HCPCS"}, {"code": "7200002", "type": "CDM"}, {"code": "00338008504", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 7.18, "maximum": 11.34, "gross_charge": 12.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 7.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXTROSE 5%/0.9% NS 1000ML", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J7042", "type": "HCPCS"}, {"code": "7200012", "type": "CDM"}, {"code": "00338008904", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.47, "maximum": 5.49, "gross_charge": 6.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 3.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGP ANTIBODY EACH IG CLASS", "code_information": [{"code": "86258", "type": "CPT"}], "standard_charges": [{"minimum": 13.26, "maximum": 13.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP B1 MAROW SMR", "code_information": [{"code": "855T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP BLD SMR PRPH", "code_information": [{"code": "854T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT COMPRE", "code_information": [{"code": "840T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT CYT 1ST", "code_information": [{"code": "843T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT CYT EA", "code_information": [{"code": "844T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT MAT PRP", "code_information": [{"code": "839T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CSLT SLD ELS", "code_information": [{"code": "838T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP C/V", "code_information": [{"code": "831T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP CONCTRJ", "code_information": [{"code": "829T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP OTH PRP", "code_information": [{"code": "833T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP OTH SCR", "code_information": [{"code": "832T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP OTH XTN", "code_information": [{"code": "834T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP SLCTV", "code_information": [{"code": "830T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP SMEARS", "code_information": [{"code": "827T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP CYTP SMPL FL", "code_information": [{"code": "828T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP ELECTRON MIC", "code_information": [{"code": "856T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP FNA 1ST EA", "code_information": [{"code": "835T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP FNA EA ADDL", "code_information": [{"code": "836T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP FNA I&R", "code_information": [{"code": "837T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP IMFLUOR 1ST", "code_information": [{"code": "845T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP IMFLUOR EA", "code_information": [{"code": "846T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP ISH 1ST", "code_information": [{"code": "848T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP ISH EA ADL 1", "code_information": [{"code": "849T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP ISH EA MULT", "code_information": [{"code": "850T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP MPHMTRC 1ST", "code_information": [{"code": "851T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP MPHMTRC ALYS", "code_information": [{"code": "763T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP MPHMTRC EA 1", "code_information": [{"code": "852T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP MPHMTRC EA M", "code_information": [{"code": "853T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP PTH CSLT 1ST", "code_information": [{"code": "841T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP PTH CSLT EA", "code_information": [{"code": "842T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL IMM 1ST", "code_information": [{"code": "760T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL IMM EA 1", "code_information": [{"code": "761T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL IMM EA M", "code_information": [{"code": "762T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL SP GRPIII", "code_information": [{"code": "759T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL SPC GRPII", "code_information": [{"code": "757T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SL SPC HCHEM", "code_information": [{"code": "758T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL II", "code_information": [{"code": "751T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL IV", "code_information": [{"code": "753T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL V", "code_information": [{"code": "754T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL VI", "code_information": [{"code": "755T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LVL III", "code_information": [{"code": "752T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD SPC GRPI", "code_information": [{"code": "756T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP XM ARCH TISS", "code_information": [{"code": "847T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DHR HAIR DRUG", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "1001008", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 51.3, "maximum": 102.04, "gross_charge": 90.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 71.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 51.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DHR URINE DRUG", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "1001007", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.49, "maximum": 38.72, "gross_charge": 32.0, "discounted_cash": 54.17, "estimated_discounted_cash": 104.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 25.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DI GNOTYP SLC4A1 EXON 19", "code_information": [{"code": "183U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN  PER INDIV", "code_information": [{"code": "G0108", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN IND/GROUP", "code_information": [{"code": "G0109", "type": "HCPCS"}], "standard_charges": [{"minimum": 146.67, "maximum": 146.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 146.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETA (GLYBURIDE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000218", "type": "CDM"}, {"code": "23155005801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIABETES PREV ONLINE/ELEC", "code_information": [{"code": "488T", "type": "CPT"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV STANDARD CURR", "code_information": [{"code": "403T", "type": "CPT"}], "standard_charges": [{"minimum": 146.67, "maximum": 146.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 146.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV STANDARD CURR", "code_information": [{"code": "A4341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH CC", "code_information": [{"code": "638", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 4235.8, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH MCC", "code_information": [{"code": "637", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DIABETES WITHOUT CC/MCC", "code_information": [{"code": "639", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DIABETIC DELUXE SHOE", "code_information": [{"code": "A5508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9141", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9465", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAG BRONCHOSCOPE/CATHETER", "code_information": [{"code": "31643", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAG LAPARO SEPARATE PROC", "code_information": [{"code": "49320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAG TST DETECT MUCOS ABNORM", "code_information": [{"code": "D0431", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY", "code_information": [{"code": "46601", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY & BIOPSY", "code_information": [{"code": "46607", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY SPX", "code_information": [{"code": "46600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC CASTS", "code_information": [{"code": "D0470", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC COLONOSCOPY", "code_information": [{"code": "45378", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31575", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC RAD SS", "code_information": [{"code": "G4001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC SIGMOIDOSCOPY", "code_information": [{"code": "45330", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYS SOL FLD VOL > 1999CC", "code_information": [{"code": "A4722", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYS SOL FLD VOL > 2999CC", "code_information": [{"code": "A4723", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYS SOL FLD VOL > 3999CC", "code_information": [{"code": "A4724", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYS SOL FLD VOL > 4999CC", "code_information": [{"code": "A4725", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYS SOL FLD VOL > 5999CC", "code_information": [{"code": "A4726", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSAT SOL FLD VOL > 249CC", "code_information": [{"code": "A4720", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSAT SOL FLD VOL > 999CC", "code_information": [{"code": "A4721", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSATE CONC POW PER PACK", "code_information": [{"code": "A4765", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSATE CONC SOL ADD 10 ML", "code_information": [{"code": "A4766", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSATE SOL TEST KIT, EACH", "code_information": [{"code": "A4760", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSATE SOLUTION, NON-DEX", "code_information": [{"code": "A4728", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS ACCESS SYSTEM", "code_information": [{"code": "C1881", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS ACU KIDNEY NO ESRD", "code_information": [{"code": "G0491", "type": "HCPCS"}], "standard_charges": [{"minimum": 2442.42, "maximum": 2442.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2442.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS BLOOD PRESSURE CUFF", "code_information": [{"code": "A4663", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS CIRCUIT EMBOLJ", "code_information": [{"code": "36909", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS EQUIPMENT NOC", "code_information": [{"code": "E1699", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS ONE EVALUATION", "code_information": [{"code": "90945", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS REPEATED EVAL", "code_information": [{"code": "90947", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING COMPLETE", "code_information": [{"code": "90989", "type": "CPT"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING INCOMPL", "code_information": [{"code": "90993", "type": "CPT"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYZER, EACH", "code_information": [{"code": "A4690", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAMOX (ACETAZOLAMIDE) 250MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003524", "type": "CDM"}, {"code": "72578015001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIAPER SERV REUSABLE DIAPER", "code_information": [{"code": "T4538", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAPERS ADULT BLUE (12 PACK)", "code_information": [{"code": "3000016", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 26.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIAPHRAGM", "code_information": [{"code": "A4266", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAS BP > OR = 90", "code_information": [{"code": "G8755", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAS BP LESS 90", "code_information": [{"code": "G8754", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAST BP 80-89 MM HG", "code_information": [{"code": "3079F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAST BP <80 MM HG", "code_information": [{"code": "3078F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAST BP >= 90 MM HG", "code_information": [{"code": "3080F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIASTAT ACUDIAL RECTAL GEL 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000948", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIATHERMY EG MICROWAVE", "code_information": [{"code": "97024", "type": "CPT"}], "standard_charges": [{"minimum": 6.56, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAZOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIDANOSINE, 25 MG", "code_information": [{"code": "S0137", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIET COUNSEL AT HOSPICE", "code_information": [{"code": "G9474", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIETHYLSTILBESTROL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9165", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIFELIKEFALIN, ESRD ON DIALY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0879", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIFLUCAN (FLUCONAZOLE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000152", "type": "CDM"}, {"code": "00904650006", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIFLUCAN 200MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1450", "type": "HCPCS"}, {"code": "7200058", "type": "CDM"}, {"code": "00409468823", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [{"code": "375", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [{"code": "374", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "376", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DIGIT NERVE SURGERY ADD-ON", "code_information": [{"code": "64778", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIGITAL BLOCK", "code_information": [{"code": "64450", "type": "CPT"}, {"code": "11000294", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 929.1, "maximum": 1467.0, "gross_charge": 1630.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1222.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1304.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1467.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 929.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGITAL SUB 2 OR MORE IMAGES", "code_information": [{"code": "D0394", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIGOXIN", "code_information": [{"code": "80162", "type": "CPT"}, {"code": "1000156", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.27, "maximum": 70.74, "gross_charge": 78.6, "discounted_cash": 54.17, "estimated_discounted_cash": 78.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGOXIN IMMUNE FAB (OVINE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1162", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIGOXIN THXPY FOR 6 MOS/>", "code_information": [{"code": "4220F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIHYDROTESTOSTERONE", "code_information": [{"code": "82642", "type": "CPT"}], "standard_charges": [{"minimum": 33.67, "maximum": 33.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIHYDROTESTOSTERONE", "code_information": [{"code": "82651", "type": "CPT"}, {"code": "1000825", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIL MACULA/FUNDUS EXAM/W DOC", "code_information": [{"code": "G8397", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILANTIN (PHENYTOIN) CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000153", "type": "CDM"}, {"code": "51672411101", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DILANTIN 100MG/2ML INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J1165", "type": "HCPCS"}, {"code": "72000750", "type": "CDM"}, {"code": "00641049325", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILANTIN 250MG/5ML INJ", "drug_information": {"unit": 5.0, "type": "EA"}, "code_information": [{"code": "J1165", "type": "HCPCS"}, {"code": "72000771", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILANTIN LEVEL", "code_information": [{"code": "80185", "type": "CPT"}, {"code": "1000051", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.24, "maximum": 70.63, "gross_charge": 78.48, "discounted_cash": 54.17, "estimated_discounted_cash": 78.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.78, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILANTIN LIQ 125MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000270", "type": "CDM"}, {"code": "60432013108", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 36.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA DIFF TER", "code_information": [{"code": "61642", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA VSL SM TER", "code_information": [{"code": "61641", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILAT MACULAR EXAM DONE", "code_information": [{"code": "2021F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILAT RTA XM EVC RTNOPTHY", "code_information": [{"code": "2022F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILAT RTA XM W/O RTNOPTHY", "code_information": [{"code": "2023F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NDURLGC PX", "code_information": [{"code": "50436", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NEW ACCESS RCS", "code_information": [{"code": "50437", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE BILIARY DUCT/AMPULLA", "code_information": [{"code": "47542", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS", "code_information": [{"code": "43453", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS 1/MULT PASS", "code_information": [{"code": "43450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE IC VASOSPASM INIT", "code_information": [{"code": "61640", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE TEAR DUCT OPENING", "code_information": [{"code": "68801", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53601", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53621", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATED FUNDUS EVAL DONE", "code_information": [{"code": "2020F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATED MACUL EXAM DONE", "code_information": [{"code": "2019F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION AND CURETTAGE", "code_information": [{"code": "58120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF ANAL SPHINCTER", "code_information": [{"code": "45905", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF CERVICAL CANAL", "code_information": [{"code": "57800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF RECTAL NARROWING", "code_information": [{"code": "45910", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42650", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42660", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53661", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53665", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION OF VAGINA", "code_information": [{"code": "57400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILATION URTR/URT RS&I", "code_information": [{"code": "74485", "type": "CPT"}], "standard_charges": [{"minimum": 152.91, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 152.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILAUDID (HYDROMORPHONE HCL) 2MG/ML INJ", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J1171", "type": "HCPCS"}, {"code": "72001000", "type": "CDM"}, {"code": "00641615125", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAUDID (HYDROMORPHONE HCL) TAB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000967", "type": "CDM"}, {"code": "42858030101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIMECAPROL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0470", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIMENHYDRINATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIMETHYL SULFOXIDE 50% 50 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1212", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIOVAN (VALSARTAN) TAB 160MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200135", "type": "CDM"}, {"code": "55111073390", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIOVAN (VALSARTAN) TAB 320 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000325", "type": "CDM"}, {"code": "51660014390", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 11.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIOVAN (VALSARTAN) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000259", "type": "CDM"}, {"code": "00078042315", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIOVAN (VALSARTAN) TAB 80MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200136", "type": "CDM"}, {"code": "50268074715", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIOVAN/HCTZ (VALSAR/HCTZ) TAB 160/12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000725", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIOVAN/HCTZ (VALSAR/HCTZ) TAB 160MG/25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000519", "type": "CDM"}, {"code": "00378632377", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIOVAN/HCTZ (VALSAR/HCTZ)TAB 80MG/12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000472", "type": "CDM"}, {"code": "00078031434", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE 0.2% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000271", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE HCL 50MG", "code_information": [{"code": "Q0163", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTIBODY", "code_information": [{"code": "86648", "type": "CPT"}], "standard_charges": [{"minimum": 17.49, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTITOXIN", "code_information": [{"code": "90296", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIPRIVAN 500MG/50ML IV", "drug_information": {"unit": 50.0, "type": "EA"}, "code_information": [{"code": "J2704", "type": "HCPCS"}, {"code": "72000938", "type": "CDM"}, {"code": "63323026950", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 18.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPROPYLACETIC ACID FREE", "code_information": [{"code": "80165", "type": "CPT"}], "standard_charges": [{"minimum": 15.57, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIRECT ADVANCED LIFE SUPPORT", "code_information": [{"code": "99288", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIRECT IMMUNOFLUORESCENCE", "code_information": [{"code": "D0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.12, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIS SITE TELE SVCS RHC/FQHC", "code_information": [{"code": "G2025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISABILITY EXAMINATION", "code_information": [{"code": "99456", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHO SEC CLSR", "code_information": [{"code": "23921", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHOULDER", "code_information": [{"code": "23920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISCOGRAPHY CERV/THOR SPINE", "code_information": [{"code": "72285", "type": "CPT"}], "standard_charges": [{"minimum": 163.39, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 163.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISCONTINUED", "code_information": [{"code": "80000825", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DISE EVAL SLP DO BRTH FLX DX", "code_information": [{"code": "42975", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISEASE MANAGEMENT PROGRAM", "code_information": [{"code": "S0315", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISEASE MGMT PER DIEM", "code_information": [{"code": "S0317", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISEASE MODIF PHARMACOTHXPY", "code_information": [{"code": "4540F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISEASE PROGN RA GOOD DOCD", "code_information": [{"code": "3476F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISEASE PROGN RA POOR DOCD", "code_information": [{"code": "3475F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2351", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "442", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "441", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "443", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [{"code": "439", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [{"code": "438", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "440", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [{"code": "883", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [{"code": "445", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [{"code": "444", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC", "code_information": [{"code": "446", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DISP COL STO BAG BREAST MILK", "code_information": [{"code": "A4287", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP FEE CONTRALATERAL BINAU", "code_information": [{"code": "V5240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP FEE CONTRALATERAL MONAU", "code_information": [{"code": "V5200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP FEE INHAL DRUGS/30 DAYS", "code_information": [{"code": "Q0513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP FEE INHAL DRUGS/90 DAYS", "code_information": [{"code": "Q0514", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP HOME GLUCOSE MONITOR", "code_information": [{"code": "A9275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP LEG BAG 19 OZ", "code_information": [{"code": "3001192", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DISP PEEP VALVE 0-20CM 30MM TUBE", "code_information": [{"code": "3001302", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 26.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DISP WOUND SUCT, DRSG/ACCESS", "code_information": [{"code": "A9272", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPENS FEE IMMUNOSUPRESSIVE", "code_information": [{"code": "Q0510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPENSE FEE INITIAL 30 DAY", "code_information": [{"code": "G0333", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPENSING FEE BINAURAL", "code_information": [{"code": "V5160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPENSING FEE, MONAURAL", "code_information": [{"code": "V5241", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOS CONT LENS", "code_information": [{"code": "S0500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE CATHETER TIPS", "code_information": [{"code": "A4860", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE CYCLER SET", "code_information": [{"code": "A4671", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE EAR CURETTES", "code_information": [{"code": "80000548", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DISPOSABLE ENDOSCOPE SHEATH", "code_information": [{"code": "A4270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE LINER/SHIELD/PAD", "code_information": [{"code": "T4535", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE PACK W/BOWEL SYST", "code_information": [{"code": "E0352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE SENSOR, CGM SYS", "code_information": [{"code": "A9276", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE UNDERPADS", "code_information": [{"code": "A4554", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISSECT BRAIN W/SCOPE", "code_information": [{"code": "62161", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92975", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIST REVAS LIGATION HEMO", "code_information": [{"code": "36838", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIST SPACE MAINT, FIXED UNIL", "code_information": [{"code": "D1575", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISTANCE LEARNING ATTENDANCE", "code_information": [{"code": "G9887", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DITROPAN (OXYBUTYNIN) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000350", "type": "CDM"}, {"code": "00904702761", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DITROPAN XL (OXYBUTYNIN) TAB 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000379", "type": "CDM"}, {"code": "27241015504", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DIURETIC THXPY FOR 6 MOS/>", "code_information": [{"code": "4221F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH 1ST VSL", "code_information": [{"code": "34710", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH EA ADDL", "code_information": [{"code": "34711", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DMD DUP/DELET ANALYSIS", "code_information": [{"code": "81161", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 320.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 320.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4081", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4082", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4087", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4088", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4149", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4153", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4154", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4155", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4164", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4176", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4178", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4187", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4189", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4193", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4197", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B5000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B5100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B9002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B9004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B9006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "E0776", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4217", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4233", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4234", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4235", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4236", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4238", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4239", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4253", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4256", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4257", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4258", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4259", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4314", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4315", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4316", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4322", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4326", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4327", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4328", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4331", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4332", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4333", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4334", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4336", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4338", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4340", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4344", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4346", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4349", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4351", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4355", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4357", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4361", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4362", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4363", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4366", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4367", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4368", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4369", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4371", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4373", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4375", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4376", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4377", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4378", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4379", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4381", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4383", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4384", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4385", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4387", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4388", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4389", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4391", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4392", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4393", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4394", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4395", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4396", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4398", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4404", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4405", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4406", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4407", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4408", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4409", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4411", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4412", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4413", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4414", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4416", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4417", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4418", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4419", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4422", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4423", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4424", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4426", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4427", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4428", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4429", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4431", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4432", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4433", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4434", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4435", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4436", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4437", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4452", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4456", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4461", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4463", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4481", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4483", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4542", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4556", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4557", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4558", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4559", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4561", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4562", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4563", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4565", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4595", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4596", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4614", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4616", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4617", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4618", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4619", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4623", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4633", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4635", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4636", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4638", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4639", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5053", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5054", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5056", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5057", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5061", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5062", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5063", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5071", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5072", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5073", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5081", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5082", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5093", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5114", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5131", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5514", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6154", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6196", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6197", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6217", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6219", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6223", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6229", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6231", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6232", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6233", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6234", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6235", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6236", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6237", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6238", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6241", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6242", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6243", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6244", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6248", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6251", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6252", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6253", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6254", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6257", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6258", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6259", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6266", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6403", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6407", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6411", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6441", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6442", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6443", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6444", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6445", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6446", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6447", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6448", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6449", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6451", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6452", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6453", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6454", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6456", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6457", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6511", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6522", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6523", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6524", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6525", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6527", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6528", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6529", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6531", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6532", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6533", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6534", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6535", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6536", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6537", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6538", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6539", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6545", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6553", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6554", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6555", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6556", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6557", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6558", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6562", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6563", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6564", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6565", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6566", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6567", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6568", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6569", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6571", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6572", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6573", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6574", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6575", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6576", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6577", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6578", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6579", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6581", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6582", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6583", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6585", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6586", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6587", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6588", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6589", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6591", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6594", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6595", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6596", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6597", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6598", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6599", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7044", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7047", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7048", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7522", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7524", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7525", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A7527", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A8000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A8001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A8002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A8003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A8004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0111", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0114", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0116", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0135", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0141", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0143", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0144", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0147", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0148", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0149", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0153", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0154", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0155", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0156", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0157", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0158", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0159", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0162", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0163", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0165", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0167", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0171", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0182", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0183", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0184", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0187", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0188", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0189", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0191", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0193", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0194", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0196", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0197", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0198", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0217", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0235", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0236", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0239", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0251", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0256", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0261", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0266", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0271", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0272", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0276", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0277", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0291", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0292", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0293", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0294", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0295", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0296", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0297", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0302", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0303", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0304", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0316", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0325", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0326", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0371", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0373", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0424", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0431", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0433", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0434", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0439", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0441", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0442", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0443", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0444", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0447", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0462", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0465", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0466", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0467", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0470", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0471", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0472", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0480", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0482", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0483", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0484", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0485", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0486", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0490", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0491", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0561", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0562", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0565", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0572", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0574", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0575", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0585", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0617", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0618", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0619", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0621", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0635", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0636", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0639", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0651", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0652", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0655", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0656", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0657", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0665", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0666", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0667", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0668", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0669", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0671", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0672", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0673", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0675", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0677", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0678", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0679", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0681", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0682", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0691", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0692", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0693", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0694", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0705", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0720", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0731", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0732", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0733", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0734", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0735", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0740", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0744", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0745", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0747", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0748", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0749", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0760", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0762", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0764", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0765", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0766", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0779", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0780", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0781", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0782", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0783", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0784", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0785", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0786", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0791", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0849", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0850", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0855", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0856", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0860", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0870", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0880", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0890", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0910", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0911", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0912", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0920", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0930", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0935", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0940", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0941", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0942", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0944", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0945", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0946", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0947", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0948", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0950", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0951", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0952", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0953", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0954", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0955", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0956", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0957", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0958", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0959", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0960", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0966", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0967", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0968", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0969", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0971", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0973", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0974", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0978", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0980", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0981", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0982", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0983", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0984", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0985", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0986", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0988", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0990", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0992", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0994", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E0995", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1084", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1087", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1088", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1092", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1093", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1171", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1195", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1223", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1226", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1227", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1228", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1231", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1232", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1233", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1234", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1235", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1236", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1237", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1238", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1295", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1296", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1297", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1298", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1355", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1391", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1392", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1405", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1406", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1701", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1800", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1801", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1802", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1805", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1806", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1810", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1811", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1812", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1815", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1816", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1818", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1820", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1821", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1825", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1831", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1841", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E1905", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2103", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2217", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2218", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2219", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2226", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2227", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2228", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2231", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2322", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2323", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2324", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2325", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2326", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2327", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2328", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2329", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2340", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2343", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2351", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2359", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2361", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2362", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2363", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2365", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2366", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2367", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2368", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2369", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2371", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2373", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2374", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2375", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2376", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2377", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2378", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2381", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2383", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2384", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2385", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2386", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2387", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2388", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2389", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2391", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2392", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2394", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2395", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2396", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2397", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2398", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2511", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2612", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2614", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2616", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2619", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2621", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2623", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2632", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E2633", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "E3000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0042", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0043", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0044", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0047", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0053", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0056", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0065", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0069", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0071", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0072", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0073", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0077", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0098", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0195", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0609", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0672", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0733", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0738", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0800", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0801", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0802", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0806", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0807", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0808", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0813", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0814", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0815", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0816", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0820", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0821", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0822", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0823", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0824", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0825", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0826", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0827", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0828", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0829", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0835", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0836", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0837", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0838", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0839", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0841", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0842", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0843", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0848", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0849", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0850", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0851", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0852", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0853", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0854", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0855", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0856", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0857", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0858", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0859", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0860", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0861", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0862", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0863", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "K0864", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0174", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0452", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0454", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0456", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0457", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0458", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0462", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0464", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0466", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0467", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0468", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0469", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0470", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0472", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0480", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0482", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0484", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0486", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0488", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0490", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0491", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0492", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0621", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0623", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0632", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0633", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0634", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0635", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0636", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0638", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0639", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0641", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0643", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0648", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0649", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0651", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0810", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0820", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0859", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0861", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0970", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0972", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0974", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0976", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0978", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0980", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0982", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0984", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1085", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1652", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1681", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1685", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1686", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1690", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1720", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1755", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1810", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1812", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1820", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1831", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1832", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1833", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1834", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1836", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1843", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1844", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1845", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1846", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1847", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1848", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1850", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1851", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1852", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1860", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1902", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1904", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1906", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1907", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1910", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1920", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1930", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1932", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1940", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1945", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1950", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1951", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1960", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1970", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1971", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1980", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L1990", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2106", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2114", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2116", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2128", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2132", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2134", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2182", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2184", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2188", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2192", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2232", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2335", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2340", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2375", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2385", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2387", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2395", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2397", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2405", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2492", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2525", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2750", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2755", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2760", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2768", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2780", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2785", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2795", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2800", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2810", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2820", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L2850", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3332", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3334", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3340", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3440", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3465", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3470", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3480", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3595", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3671", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3674", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3675", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3720", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3740", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3760", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3761", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3762", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3763", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3764", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3765", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3766", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3806", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3807", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3808", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3809", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3901", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3904", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3905", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3906", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3908", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3912", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3913", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3915", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3916", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3917", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3918", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3919", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3921", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3923", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3924", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3925", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3927", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3929", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3930", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3931", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3933", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3935", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3956", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3960", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3962", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3967", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3971", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3973", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3975", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3976", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3977", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3978", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3980", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3981", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3982", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3984", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L3995", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4361", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4386", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4387", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4392", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4394", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4396", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4397", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4398", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L4631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5331", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5535", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5585", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5595", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5614", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5616", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5617", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5618", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5632", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5634", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5636", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5638", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5639", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5643", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5644", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5645", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5646", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5647", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5648", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5649", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5651", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5652", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5653", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5654", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5655", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5656", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5658", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5661", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5665", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5666", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5668", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5671", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5672", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5673", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5676", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5677", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5678", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5679", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5681", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5682", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5683", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5684", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5685", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5686", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5688", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5690", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5692", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5694", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5695", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5696", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5697", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5698", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5699", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5701", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5703", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5704", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5705", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5706", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5707", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5711", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5712", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5714", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5716", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5718", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5722", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5724", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5726", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5728", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5780", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5781", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5782", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5785", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5790", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5795", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5810", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5811", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5812", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5814", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5816", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5818", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5822", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5824", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5826", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5828", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5845", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5848", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5850", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5855", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5856", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5857", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5858", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5859", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5910", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5920", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5925", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5926", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5930", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5940", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5950", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5960", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5962", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5964", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5966", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5968", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5970", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5971", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5972", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5973", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5974", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5975", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5976", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5978", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5979", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5980", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5981", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5982", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5984", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5985", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5986", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5987", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5988", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5990", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L5991", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6384", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6386", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6388", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6582", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6584", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6586", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6588", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6616", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6621", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6623", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6632", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6635", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6638", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6641", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6645", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6646", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6647", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6648", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6655", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6665", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6672", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6675", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6676", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6677", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6682", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6684", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6686", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6687", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6688", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6689", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6690", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6691", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6692", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6693", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6694", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6695", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6696", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6697", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6698", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6703", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6704", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6706", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6707", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6708", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6709", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6711", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6712", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6713", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6714", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6715", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6721", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6722", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6805", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6810", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6880", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6881", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6882", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6883", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6884", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6885", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6890", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6895", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6905", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6910", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6915", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6920", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6925", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6930", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6935", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6940", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6945", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6950", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6955", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6960", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6965", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6970", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L6975", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7191", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7259", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7362", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7366", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7367", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7368", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7401", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7403", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7404", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7405", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L7700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8042", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8043", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8044", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8047", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8417", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8435", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8440", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8465", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8470", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8480", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8485", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8511", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8514", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8609", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8612", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8614", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8616", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8617", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8618", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8619", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8621", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8623", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8641", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8658", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8659", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8678", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8679", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8681", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8682", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8683", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8684", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8689", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8690", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8691", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8693", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8694", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8695", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8696", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0477", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0478", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0479", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0480", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0481", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0482", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0483", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0484", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0485", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0486", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0487", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0489", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0490", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0491", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0492", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0493", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0494", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0495", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0496", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0497", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0498", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0499", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4042", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4043", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4044", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4047", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4048", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4049", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2103", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2104", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2106", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2107", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2109", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2111", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2114", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2115", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2118", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2218", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2219", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2302", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2303", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2304", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2306", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2307", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2308", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2309", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2314", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2315", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2318", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2319", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2511", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2522", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2523", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2524", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2531", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2623", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2632", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2715", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2718", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2744", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2745", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2750", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2755", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2760", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2762", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2770", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2780", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2782", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2783", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2784", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2786", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME SUPPLY OR ACCESSORY, NOS", "code_information": [{"code": "A9999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DMPK GENE CHARAC ALLELES", "code_information": [{"code": "81239", "type": "CPT"}], "standard_charges": [{"minimum": 316.05, "maximum": 316.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DMPK GENE DETC ABNOR ALLELE", "code_information": [{"code": "81234", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS APOE ALZHEIMER", "code_information": [{"code": "S3852", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS DEAFNESS", "code_information": [{"code": "S3844", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS RET-ONCOGENE", "code_information": [{"code": "S3840", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DNA ANTB 2STRAND HI AVIDITY", "code_information": [{"code": "39U", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DNA ANTIBODY SINGLE STRAND", "code_information": [{"code": "86226", "type": "CPT"}], "standard_charges": [{"minimum": 13.93, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DNA/RNA AMPLIFIED PROBE", "code_information": [{"code": "87150", "type": "CPT"}], "standard_charges": [{"minimum": 23.08, "maximum": 40.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DNA/RNA DIRECT PROBE", "code_information": [{"code": "87149", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DNA/RNA SEQUENCING", "code_information": [{"code": "87153", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 132.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 132.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DO GNOTYP ART4 EXON 2", "code_information": [{"code": "184U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "3000025", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "3000053", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "3000054", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "3000055", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "3000056", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "3000078", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "3000552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "3001199", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 11.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000509", "type": "CDM"}, {"code": "00004081095", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200051", "type": "CDM"}, {"code": "58016039120", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DO NOT USE", "code_information": [{"code": "80000486", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DOBUTREX (DOBUTAMINE) 250MG/20ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1250", "type": "HCPCS"}, {"code": "7000165", "type": "CDM"}, {"code": "00409234401", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOC 2ND RECOM HZV 2-6 MO INT", "code_information": [{"code": "M1238", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC 2X RE-ASSESS FILT REMOV", "code_information": [{"code": "G9543", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC >1 DOSE REDUC TECH", "code_information": [{"code": "G9637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC >1 SINUS CT W 90D DX", "code_information": [{"code": "G9351", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ACTIVE INJ DRUG USE", "code_information": [{"code": "G9518", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ADVNCD DIS CMFRT NOT 1ST", "code_information": [{"code": "1153F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ADVNCD DIS COMFORT 1ST", "code_information": [{"code": "1152F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ANTIBIO GIVEN B/4 SURG", "code_information": [{"code": "4046F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ANTIBIO GIVEN B/4 SURG", "code_information": [{"code": "4047F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ANTIBIO GIVEN B/4 SURG", "code_information": [{"code": "4048F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ANTIBIO NOT GIVEN", "code_information": [{"code": "4042F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC CHLAM SCR TEST W/FOLLOW", "code_information": [{"code": "G9820", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC COMM RISK CALC", "code_information": [{"code": "G9316", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC COUNT OF CT IN 12MO", "code_information": [{"code": "G9321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC DAILY ASPIRIN OR CONTRA", "code_information": [{"code": "G9277", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ESRD DIA TRANS PREG", "code_information": [{"code": "G9231", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC FCN/CARE PLAN W/30 DAYS", "code_information": [{"code": "G8942", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC FE+ STORES B/4 EPO THX", "code_information": [{"code": "3160F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC FUNCT AND CARE PLAN", "code_information": [{"code": "G8539", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC FUNCT NO DEFICIENCIES", "code_information": [{"code": "G8542", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC FX & TEST/TXMNT FOR OP", "code_information": [{"code": "5015F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC HX RENAL FAIL OR CR+ >=4", "code_information": [{"code": "G9722", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC IMM CKPT INHIB HLD", "code_information": [{"code": "M1183", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC IMMUNE HEP B ANTITNF", "code_information": [{"code": "G8869", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC KHE NOT PEF W/EFGR/UACR", "code_information": [{"code": "M1190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC KHE PEF W/EFGR/UACR", "code_information": [{"code": "M1189", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC LACK PERM&CONT&PAROX FIB", "code_information": [{"code": "1061F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MD RSN NO ANTIPLA", "code_information": [{"code": "G9610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED NOT PRESB", "code_information": [{"code": "G8968", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED PT REAS NO HCC SCRN", "code_information": [{"code": "G9456", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED REAS NO HCV TEST", "code_information": [{"code": "G9452", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED REAS NO PNEUMOCOCCAL", "code_information": [{"code": "G8865", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN <3 COLON", "code_information": [{"code": "G9998", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN FOR F/U IMAG", "code_information": [{"code": "G9549", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN FOR FOLLUP IMAGE", "code_information": [{"code": "G9555", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO ADR DEP THRPY", "code_information": [{"code": "G9895", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO COMBO THRPY", "code_information": [{"code": "G9957", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO CST/IST RX", "code_information": [{"code": "M1184", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO DAILY ASPIRIN", "code_information": [{"code": "G9794", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO FLLW UP", "code_information": [{"code": "G9755", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO FLU VAX", "code_information": [{"code": "M1169", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO HCV SCRN", "code_information": [{"code": "G9384", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO HZV", "code_information": [{"code": "M1175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO MEDREC", "code_information": [{"code": "G8430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO PCV", "code_information": [{"code": "M1178", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO PROPH ANTIEM", "code_information": [{"code": "G9776", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO PT CAT", "code_information": [{"code": "G9429", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO SRN TB", "code_information": [{"code": "M1004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO TD/TDAP", "code_information": [{"code": "M1172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NO TEMP >= 35.5", "code_information": [{"code": "G9772", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NOT PERF CYSTOSC", "code_information": [{"code": "G9607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN NOT SEEN", "code_information": [{"code": "M1325", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN PRESC ANBX", "code_information": [{"code": "G9712", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MED RSN SCOPE PT >= 86Y", "code_information": [{"code": "G9660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MEDRSN NO HIST TYPE RPT", "code_information": [{"code": "G9288", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MEDRSN NO HISTO TYPE", "code_information": [{"code": "G9282", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC MNTL TST B/4 BK TRXMNT", "code_information": [{"code": "2044F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC NEG ELD REQ", "code_information": [{"code": "G8734", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC NEW DIAG 1ST/ADDL MDD", "code_information": [{"code": "3093F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC NO DAILY ASPIRIN", "code_information": [{"code": "G9278", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC NO DICOM, CT OTHER FAC", "code_information": [{"code": "G9753", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC NO PT RSK DEATH W/IN 1YR", "code_information": [{"code": "1151F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC OF DSM-IV INIT EVAL", "code_information": [{"code": "G9212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC OF NON TOBACCO USER", "code_information": [{"code": "G9275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC OF PT PRM HDA DX AND OTR", "code_information": [{"code": "M1028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC OF TOBACCO USER", "code_information": [{"code": "G9276", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ORDER ANTI-PLAT", "code_information": [{"code": "G9609", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ORDER CEFAZOLIN/CEFUROX", "code_information": [{"code": "4041F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ORDER GIVEN STOP ANTIBIO", "code_information": [{"code": "4043F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ORDER GIVEN STOP ANTIBIO", "code_information": [{"code": "4049F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC ORDER GIVEN VTE PROPHYLX", "code_information": [{"code": "4044F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PAT DECLINED THERAPY", "code_information": [{"code": "G9765", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PERM/CONT/PAROX ATR FIB", "code_information": [{"code": "1060F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC POS ELDER MAL SCRN PLAN", "code_information": [{"code": "G8733", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT DISCHG <=2D", "code_information": [{"code": "G9255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT DISCHG >2D", "code_information": [{"code": "G9254", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT DX BIPOL", "code_information": [{"code": "G9717", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT HCV ABY RNA TST", "code_information": [{"code": "M1235", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT NOT ON STATIN", "code_information": [{"code": "G9508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT PAL OR HOSPICE", "code_information": [{"code": "G9996", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT PAL OR HOSPICE", "code_information": [{"code": "M1307", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT PREG DUR MSRMT PD", "code_information": [{"code": "G9997", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT PREG DUR MSRMT PD", "code_information": [{"code": "M1298", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT REAS NO PNEUMOCOCCAL", "code_information": [{"code": "G8866", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT REAS NOT REC HCV SRN", "code_information": [{"code": "G9385", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT RSK DEATH W/IN 1YR", "code_information": [{"code": "1150F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT RSN NO ADR DEP THRPY", "code_information": [{"code": "G9896", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT RSN NO PRESC WARF/FDA", "code_information": [{"code": "G8969", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PT UNABLE COMM", "code_information": [{"code": "G2183", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PTS RSN NO F/U XM", "code_information": [{"code": "M1330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC PTS RSN NO F/U XM", "code_information": [{"code": "M1335", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO AHI OR RDI", "code_information": [{"code": "G8843", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO MIN INV DX", "code_information": [{"code": "G8876", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO POS AIR PRESS", "code_information": [{"code": "G8849", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO SLEEP APNEA", "code_information": [{"code": "G8840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO STATIN MED DISCH", "code_information": [{"code": "G8817", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO STATIN THERAPY", "code_information": [{"code": "G8815", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO STATIN THERAPY", "code_information": [{"code": "G9940", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS ON STATIN OR CONTRA", "code_information": [{"code": "G9507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REASS APPR REMO FILT 3MS", "code_information": [{"code": "G9542", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC RECPT COUNSL VIT D/CALC+", "code_information": [{"code": "4019F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REF UPPER GI ENDOSCOPY", "code_information": [{"code": "3132F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REHAB SVCS CONSIDERED", "code_information": [{"code": "4079F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC RSN ELECT C-SEC/INDUCT", "code_information": [{"code": "G9361", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC RSN HEP B STAT NOT ASSES", "code_information": [{"code": "G9504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC RSN NO 10 YR FOLLOW", "code_information": [{"code": "G9862", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC RSN NO HBP SCRN OR F/U", "code_information": [{"code": "G9745", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC RSN NO HBP SCRN OR F/U", "code_information": [{"code": "M1288", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC RSN NO STATIN", "code_information": [{"code": "G9781", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC SEX ACTIVITY", "code_information": [{"code": "G9818", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC SHARE DEC PRIOR PROC", "code_information": [{"code": "G9296", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC SHNT/TUM/COAG", "code_information": [{"code": "G9595", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC SYS RSN <3 COLON", "code_information": [{"code": "G9999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC SYSM RSN IMG HD", "code_information": [{"code": "M1029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC T-PA ADMIN CONSIDERED", "code_information": [{"code": "4077F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC TB SCRNG-RSLTS INTERPD", "code_information": [{"code": "3510F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC TYPE NSM LUNG CA", "code_information": [{"code": "G9289", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC VIRAL LOAD <200", "code_information": [{"code": "G9243", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC VIRAL LOAD >=200", "code_information": [{"code": "G9242", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCETAXEL (INGENUS), 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCETAXEL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9171", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.3, "maximum": 631.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCREV CUR MEDS BY ELIG CLIN", "code_information": [{"code": "G8427", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1107", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1127", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCU DX DEGEN NEURO", "code_information": [{"code": "M1131", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOLASETRON 50 MG", "code_information": [{"code": "S0174", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOLASETRON MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOLASETRON MESYLATE ORAL", "code_information": [{"code": "Q0180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOMEBORO (ALUMINUM ACETATE) PCKT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000167", "type": "CDM"}, {"code": "16500002324", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY LAPS LIV", "code_information": [{"code": "666T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN CDVR", "code_information": [{"code": "664T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN LIV", "code_information": [{"code": "665T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY RCP UTER", "code_information": [{"code": "667T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DONNATAL (BELLADONNA ALK/PB) TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000116", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DONNATAL (belladonna alk) ELIX 16.2/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200037", "type": "CDM"}, {"code": "59212042204", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 45.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DONOR LOBECTOMY (LUNG)", "code_information": [{"code": "S2061", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DONOR PANCREATECTOMY", "code_information": [{"code": "48550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DONOR PNEUMONECTOMY", "code_information": [{"code": "32850", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DONOR SERV IVF CASE RATE", "code_information": [{"code": "S4025", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOOR TO PUNC TIME <2HRS", "code_information": [{"code": "G9580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOOR TO PUNC TIME >2HR, NRG", "code_information": [{"code": "G9582", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOPAMINE 400MG/5ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1265", "type": "HCPCS"}, {"code": "7000168", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93321", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOPPLER FLOW TESTING", "code_information": [{"code": "93990", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DORIBAX 500MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1267", "type": "HCPCS"}, {"code": "72000888", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 42.18, "maximum": 66.6, "gross_charge": 74.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 59.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 66.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 42.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORIBAX 500MG/100 ML .9% NS IVPB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1267", "type": "HCPCS"}, {"code": "72000889", "type": "CDM"}, {"code": "50458040102", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 42.18, "maximum": 66.6, "gross_charge": 74.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 59.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 66.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 42.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORNASE ALFA NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7639", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOSE OPTIMIZATION AUC - 5FU", "code_information": [{"code": "S3722", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOUBLE TRANSFER TOE-HAND", "code_information": [{"code": "26554", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOXORUBICIN HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOXORUBICIN INJ 10MG", "code_information": [{"code": "Q2050", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOXY (DOXYCYCLINE) 100MG/100ML .9% NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000969", "type": "CDM"}, {"code": "63323013013", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 20.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DOXYCYCLINE TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000171", "type": "CDM"}, {"code": "00904043006", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DPYD GENE COMMON VARIANTS", "code_information": [{"code": "81232", "type": "CPT"}], "standard_charges": [{"minimum": 201.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN APPENDIX ABSCESS OPEN", "code_information": [{"code": "44900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN BAG W/PRIVACY COVER FIG LEAF", "code_information": [{"code": "3001364", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRAIN BAG/BOTTLE", "code_information": [{"code": "A4911", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN BL W/CATH INSERTION", "code_information": [{"code": "51102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY NEEDLE", "code_information": [{"code": "51100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY TROCAR/CATH", "code_information": [{"code": "51101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN CHEST LESION", "code_information": [{"code": "21502", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69000", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69005", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN HAND TENDON SHEATH", "code_information": [{"code": "26020", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG BURSA", "code_information": [{"code": "27604", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG LESION", "code_information": [{"code": "27603", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN NECK/CHEST LESION", "code_information": [{"code": "21501", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN ABDOM ABSCESS", "code_information": [{"code": "49040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN LUNG LESION", "code_information": [{"code": "32200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN RETROPERI ABSCESS", "code_information": [{"code": "49060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OUTER EAR CANAL LESION", "code_information": [{"code": "69020", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS OPEN", "code_information": [{"code": "58820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS PERCUT", "code_information": [{"code": "58822", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN PANCREATIC PSEUDOCYST", "code_information": [{"code": "48510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN PENIS LESION", "code_information": [{"code": "54015", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BONE LESION", "code_information": [{"code": "23035", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BURSA", "code_information": [{"code": "23031", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER LESION", "code_information": [{"code": "23030", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN SPINAL CORD CYST", "code_information": [{"code": "62268", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN THIGH/KNEE LESION", "code_information": [{"code": "27301", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN THYROID/TONGUE CYST", "code_information": [{"code": "60000", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN TO PERITONEAL CAVITY", "code_information": [{"code": "49062", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN TUBE/DETACHMEN", "code_information": [{"code": "3000168", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/O US", "code_information": [{"code": "20600", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/O US", "code_information": [{"code": "20605", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20604", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20606", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE ABDOM ABSCESS OPEN", "code_information": [{"code": "49020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE EXT LINE, DIALYSIS", "code_information": [{"code": "A4672", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38300", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38305", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE MOUTH ROOF LESION", "code_information": [{"code": "42000", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABDOMEN", "code_information": [{"code": "48000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BLADDER ABSCESS", "code_information": [{"code": "51080", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "21510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "26992", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "27303", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BURSA OF FOOT", "code_information": [{"code": "28001", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65800", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65810", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65815", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYELID ABSCESS", "code_information": [{"code": "67700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FINGER ABSCESS", "code_information": [{"code": "26011", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM BURSA", "code_information": [{"code": "25031", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM LESION", "code_information": [{"code": "25028", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GLAND ABSCESS", "code_information": [{"code": "56420", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GUM LESION", "code_information": [{"code": "41800", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HIP JOINT", "code_information": [{"code": "27030", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HYDROCELE", "code_information": [{"code": "55000", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF KIDNEY LESION", "code_information": [{"code": "50390", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40800", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40801", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41000", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41005", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41006", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41007", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41008", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41009", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41015", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41016", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41017", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41018", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30000", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30020", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58805", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSA", "code_information": [{"code": "26025", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSAS", "code_information": [{"code": "26030", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "45000", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "57010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC FLUID", "code_information": [{"code": "57020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS BURSA", "code_information": [{"code": "26991", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS LESION", "code_information": [{"code": "26990", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "52700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55725", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45005", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45020", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY CYST", "code_information": [{"code": "42409", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42300", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42305", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42310", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42320", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM", "code_information": [{"code": "54700", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM ABSCESS", "code_information": [{"code": "55100", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63172", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63173", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42720", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42725", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF TONSIL ABSCESS", "code_information": [{"code": "42700", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53040", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53060", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53080", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53085", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAPE 24X36 FLOTH FENS", "code_information": [{"code": "3001048", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRAWING FEE - VENIPUNCTURE", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1000069", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.27, "maximum": 9.9, "gross_charge": 11.0, "discounted_cash": 54.17, "estimated_discounted_cash": 11.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 8.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 6.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAWTEX HYDROCONDUCTIVE DRESSING", "code_information": [{"code": "3001377", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRE W/O RTNOPTHY", "code_information": [{"code": "M1221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRE WTH INTERP RTNOPTHY", "code_information": [{"code": "M1220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRESS. AFM Ag SELECT SILVER 4X5", "code_information": [{"code": "3001338", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 26.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESS. CALCIUM AG 12 ROPE", "code_information": [{"code": "3001333", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESS. CALCIUM AG 4X4", "code_information": [{"code": "3001334", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESS. MAXORB EXTRA ROPE 1X12", "code_information": [{"code": "3001363", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESSING ADHES. ISLAND 4X10", "code_information": [{"code": "3001348", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESSING ADHES. ISLAND 4X14", "code_information": [{"code": "3001347", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESSING CHANGE FEE", "code_information": [{"code": "10000003", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 506.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESSING CHANGE NOT FOR BURN", "code_information": [{"code": "15852", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRESSING CHG COMPLEX-EST PT", "code_information": [{"code": "99213", "type": "CPT"}, {"code": "11000252", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 125.99, "maximum": 198.93, "gross_charge": 221.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 165.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 176.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 198.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 125.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING CHG COMPLEX-NEW PT", "code_information": [{"code": "99203", "type": "CPT"}, {"code": "11000253", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 165.8, "maximum": 261.79, "gross_charge": 290.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 218.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 232.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 261.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 165.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING CHG SIMPLE-EST PT", "code_information": [{"code": "99212", "type": "CPT"}, {"code": "11000251", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 125.99, "maximum": 198.93, "gross_charge": 221.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 165.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 176.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 198.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 125.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING CHG SIMPLE-NEW PT", "code_information": [{"code": "99202", "type": "CPT"}, {"code": "11000249", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 125.99, "maximum": 198.93, "gross_charge": 221.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 165.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 176.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 198.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 125.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING CURITY NON-ADH 3X8", "code_information": [{"code": "3001031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.62, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESSING MED/HNY CAL", "code_information": [{"code": "3001270", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESSING ULCER 6.5 X", "code_information": [{"code": "3000485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESSING VERSATEL SILICONE NON-ADH 3X4", "code_information": [{"code": "3001421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRESSING VISCOPASTE 3 X10YD", "code_information": [{"code": "3001425", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR DRAINAGE", "code_information": [{"code": "61108", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR IMPLANTATION", "code_information": [{"code": "61107", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DROPERIDOL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1790", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ADMIN & HEMODYNMIC MEAS", "code_information": [{"code": "93463", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY 120+ RX&METABLT", "code_information": [{"code": "328U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ACETAMINOPHEN", "code_information": [{"code": "80143", "type": "CPT"}], "standard_charges": [{"minimum": 21.44, "maximum": 21.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ADALIMUMAB", "code_information": [{"code": "80145", "type": "CPT"}], "standard_charges": [{"minimum": 44.36, "maximum": 44.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY AMIODARONE", "code_information": [{"code": "80151", "type": "CPT"}], "standard_charges": [{"minimum": 21.44, "maximum": 21.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY CAFFEINE", "code_information": [{"code": "80155", "type": "CPT"}], "standard_charges": [{"minimum": 33.57, "maximum": 44.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY CLOZAPINE", "code_information": [{"code": "80159", "type": "CPT"}], "standard_charges": [{"minimum": 23.17, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY EVEROLIMUS", "code_information": [{"code": "80169", "type": "CPT"}], "standard_charges": [{"minimum": 15.79, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY FELBAMATE", "code_information": [{"code": "80167", "type": "CPT"}], "standard_charges": [{"minimum": 21.44, "maximum": 21.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY FLECAINIDE", "code_information": [{"code": "80181", "type": "CPT"}], "standard_charges": [{"minimum": 21.44, "maximum": 21.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY INFLIXIMAB", "code_information": [{"code": "80230", "type": "CPT"}], "standard_charges": [{"minimum": 44.36, "maximum": 44.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ITRACONAZOLE", "code_information": [{"code": "80189", "type": "CPT"}], "standard_charges": [{"minimum": 31.18, "maximum": 31.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY LACOSAMIDE", "code_information": [{"code": "80235", "type": "CPT"}], "standard_charges": [{"minimum": 31.18, "maximum": 31.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY LEFLUNOMIDE", "code_information": [{"code": "80193", "type": "CPT"}], "standard_charges": [{"minimum": 44.36, "maximum": 44.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY METHOTREXATE", "code_information": [{"code": "80204", "type": "CPT"}], "standard_charges": [{"minimum": 44.36, "maximum": 44.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY POSACONAZOLE", "code_information": [{"code": "80187", "type": "CPT"}], "standard_charges": [{"minimum": 31.18, "maximum": 31.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY RUFINAMIDE", "code_information": [{"code": "80210", "type": "CPT"}], "standard_charges": [{"minimum": 31.18, "maximum": 31.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY SALICYLATE", "code_information": [{"code": "80179", "type": "CPT"}], "standard_charges": [{"minimum": 21.44, "maximum": 21.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY VEDOLIZUMAB", "code_information": [{"code": "80280", "type": "CPT"}], "standard_charges": [{"minimum": 44.36, "maximum": 44.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY VORICONAZOLE", "code_information": [{"code": "80285", "type": "CPT"}], "standard_charges": [{"minimum": 31.18, "maximum": 31.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ASY HYDROXYCHLOROQUINE", "code_information": [{"code": "80220", "type": "CPT"}], "standard_charges": [{"minimum": 21.44, "maximum": 21.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG DELIVERY SYSTEM <=50 ML", "code_information": [{"code": "A4306", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG DELIVERY SYSTEM >=50 ML", "code_information": [{"code": "A4305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN AMPHETAMINES 1/2", "code_information": [{"code": "80324", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN DOT", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "1000267", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.49, "maximum": 77.46, "gross_charge": 86.07, "discounted_cash": 54.17, "estimated_discounted_cash": 104.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN NON-DOT", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "1000268", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.49, "maximum": 77.46, "gross_charge": 86.07, "discounted_cash": 54.17, "estimated_discounted_cash": 104.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUAN LAMOTRIGINE", "code_information": [{"code": "80175", "type": "CPT"}], "standard_charges": [{"minimum": 15.24, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANT GABAPENTIN", "code_information": [{"code": "80171", "type": "CPT"}], "standard_charges": [{"minimum": 24.92, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANT TIAGABINE", "code_information": [{"code": "80199", "type": "CPT"}], "standard_charges": [{"minimum": 31.18, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANT ZONISAMIDE", "code_information": [{"code": "80203", "type": "CPT"}], "standard_charges": [{"minimum": 15.24, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANTALCOHOLS", "code_information": [{"code": "80320", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING BUPRENORPHINE", "code_information": [{"code": "80348", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING COCAINE", "code_information": [{"code": "80353", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING FENTANYL", "code_information": [{"code": "80354", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING OXYCODONE", "code_information": [{"code": "80365", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING PREGABALIN", "code_information": [{"code": "80366", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING PROPOXYPHENE", "code_information": [{"code": "80367", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING TAPENTADOL", "code_information": [{"code": "80372", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING TRAMADOL", "code_information": [{"code": "80373", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCRN QUAN MYCOPHENOLATE", "code_information": [{"code": "80180", "type": "CPT"}], "standard_charges": [{"minimum": 20.76, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG SCRN QUANT OXCARBAZEPIN", "code_information": [{"code": "80183", "type": "CPT"}], "standard_charges": [{"minimum": 15.24, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 15-21 CLASSES", "code_information": [{"code": "G0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 102.04, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 22+ CLASSES", "code_information": [{"code": "G0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 102.04, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 8-14 CLASSES", "code_information": [{"code": "G0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 102.04, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF SIMPLE ALL CL", "code_information": [{"code": "G0659", "type": "HCPCS"}], "standard_charges": [{"minimum": 102.04, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG TEST PRSMV INSTRMNT", "code_information": [{"code": "80306", "type": "CPT"}], "standard_charges": [{"minimum": 19.71, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG/BIO NOC PART B DRUG CAP", "code_information": [{"code": "Q4082", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 1-3", "code_information": [{"code": "80375", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 4-6", "code_information": [{"code": "80376", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 7/MORE", "code_information": [{"code": "80377", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUGS/MEDS DISP FOR HOME USE", "code_information": [{"code": "D9630", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSCHRG MED/CURRENT MED MERGE", "code_information": [{"code": "1111F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSM-5 INFO MDD DOCD", "code_information": [{"code": "1040F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G .5 /<", "code_information": [{"code": "17270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 0.6-1", "code_information": [{"code": "17271", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 1.1-2", "code_information": [{"code": "17272", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 2.1-3", "code_information": [{"code": "17273", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 3.1-4", "code_information": [{"code": "17274", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G >4.0", "code_information": [{"code": "17276", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .5/<", "code_information": [{"code": "17280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .6-1", "code_information": [{"code": "17281", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M1.1-2", "code_information": [{"code": "17282", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M2.1-3", "code_information": [{"code": "17283", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M3.1-4", "code_information": [{"code": "17284", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M>4.0", "code_information": [{"code": "17286", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ EXTENSIVE RETINOPATHY", "code_information": [{"code": "67227", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION LID MARGIN <1CM", "code_information": [{"code": "67850", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L .6-1.0CM", "code_information": [{"code": "17261", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 0.5 CM/<", "code_information": [{"code": "17260", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 1.1-2.0", "code_information": [{"code": "17262", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 2.1-3.0", "code_information": [{"code": "17263", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 3.1-4.0", "code_information": [{"code": "17264", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L >4.0 CM", "code_information": [{"code": "17266", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "419T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "420T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRJ NULYT AGT GNCLR NRV", "code_information": [{"code": "64624", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DSTRY EYE LESN,FDR VSSL TECH", "code_information": [{"code": "G0186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DT VACCINE UNDER 7 YRS IM", "code_information": [{"code": "90702", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DTAP VACCINE < 7 YRS IM", "code_information": [{"code": "90700", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DTAP-HEP B-IPV VACCINE IM", "code_information": [{"code": "90723", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV VACCINE 4-6 YRS IM", "code_information": [{"code": "90696", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV-HIB-HEPB VACCINE IM", "code_information": [{"code": "90697", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV/HIB VACCINE IM", "code_information": [{"code": "90698", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DUAL LAYER IMPAX, PER SQ CM", "code_information": [{"code": "Q4262", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DULCOLAX (BISACODYL) SUPP 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000126", "type": "CDM"}, {"code": "00574705012", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DULCOLAX (BISACODYL) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000247", "type": "CDM"}, {"code": "00904640761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DUODENAL EXCLUSION", "code_information": [{"code": "48547", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DUODENAL MOTILITY STUDY", "code_information": [{"code": "91022", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DUODERM 4 X 4 ULCER CGF", "code_information": [{"code": "3000486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DUODERM HYDROACTIVE", "code_information": [{"code": "3000487", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DUODERM XTRA THIN SPOTS 1.75 X 1.5", "code_information": [{"code": "3001445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DUONEB (ALBU/IPRAT) INH 3MG/0.5MG/3ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000173", "type": "CDM"}, {"code": "47335075652", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL BI STD", "code_information": [{"code": "93985", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL UNI STD", "code_information": [{"code": "93986", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DUP/COPY PATIENT'S RECORDS", "code_information": [{"code": "D9961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DURABLE MEDICAL EQUIPMENT MI", "code_information": [{"code": "E1399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DURAGESIC (FENTANYL) PTCH 100 MCG/HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000241", "type": "CDM"}, {"code": "00378912498", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 33.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DURAGESIC (FENTANYL) PTCH 12 MCG/HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000614", "type": "CDM"}, {"code": "00378911998", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 27.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DURAGESIC (FENTANYL) PTCH 25 MCG/HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000189", "type": "CDM"}, {"code": "47781042447", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DURAGESIC (FENTANYL) PTCH 50 MCG/HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000190", "type": "CDM"}, {"code": "00378912298", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DURAGESIC (FENTANYL) PTCH 75 MCG/HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000174", "type": "CDM"}, {"code": "47781042747", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 62.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DURICEF (CEFADROXIL) 500MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002737", "type": "CDM"}, {"code": "68180018001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.72, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DVT PROPHYLX RECVD DAY 2", "code_information": [{"code": "4070F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DWELLING LEAD INVESTIGATION", "code_information": [{"code": "T1029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR 1ST", "code_information": [{"code": "92622", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR EACH", "code_information": [{"code": "92623", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX ALYS VSTBLR IMPLT UNI 1ST", "code_information": [{"code": "728T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX ALYS VSTBLR IMPLT UNI SBQ", "code_information": [{"code": "729T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BIPOL, DEATH, NHRES, HOSP", "code_information": [{"code": "G9394", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASPIRATIONS", "code_information": [{"code": "38220", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "38221", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BX & ASPIR", "code_information": [{"code": "38222", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BRONCH W/ NAVIGATION", "code_information": [{"code": "C7509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/BRUSH", "code_information": [{"code": "31623", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/LAVAGE", "code_information": [{"code": "31624", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/WASH", "code_information": [{"code": "31622", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX DARK ADAPTATION EXAM I&R", "code_information": [{"code": "92284", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX DEGEN NEURO", "code_information": [{"code": "G2151", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPEC", "code_information": [{"code": "43756", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPECS", "code_information": [{"code": "43757", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPEC", "code_information": [{"code": "43754", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPECS", "code_information": [{"code": "43755", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPCAR US CHD I&R", "code_information": [{"code": "76989", "type": "CPT"}], "standard_charges": [{"minimum": 43.67, "maximum": 43.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPICAR CAR US CHD", "code_information": [{"code": "76987", "type": "CPT"}], "standard_charges": [{"minimum": 117.48, "maximum": 117.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 117.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP THORACIC AORTA US", "code_information": [{"code": "76984", "type": "CPT"}], "standard_charges": [{"minimum": 38.01, "maximum": 38.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY EXCL NB", "code_information": [{"code": "31525", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY NEWBORN", "code_information": [{"code": "31520", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY W/OPER SCOPE", "code_information": [{"code": "31526", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR", "code_information": [{"code": "62270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR W/FLUOR/CT", "code_information": [{"code": "62328", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX NTROP EPCR US CHD IMG ACQ", "code_information": [{"code": "76988", "type": "CPT"}], "standard_charges": [{"minimum": 74.59, "maximum": 74.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX URI 3D AFTER OTHER DX", "code_information": [{"code": "G2097", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DXA (HIPS, PELVIS, OR SPINE)", "code_information": [{"code": "77080", "type": "CPT"}, {"code": "2000120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 46.71, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 253.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA (RADIUS, WRIST, HEEL)", "code_information": [{"code": "77081", "type": "CPT"}, {"code": "2000119", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 39.24, "maximum": 253.28, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 253.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY STUDY", "code_information": [{"code": "77085", "type": "CPT"}], "standard_charges": [{"minimum": 64.24, "maximum": 253.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 64.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 253.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYAZIDE (TRIAMT/HCTZ) CAP 37.5MG/25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000113", "type": "CDM"}, {"code": "68084075025", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DYNAMIC CAVERNOSOMETRY", "code_information": [{"code": "54231", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYNAMIC STANDING FRAME", "code_information": [{"code": "E0642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYNAMIC SURFACE EMG", "code_information": [{"code": "96002", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYPHYLLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "DYSPHAG TEST DONE B/4 EATING", "code_information": [{"code": "6010F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYSPHAG TEST DONE B/4 EATING", "code_information": [{"code": "6015F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYSPHAGIA SCREENING", "code_information": [{"code": "V5364", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYSPNEA MNGMNT PLAN DOCD", "code_information": [{"code": "535F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYSPNEA NOT SCREENED", "code_information": [{"code": "3452F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYSPNEA SCRND MOD-HIGH DYSP", "code_information": [{"code": "3451F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYSPNEA SCRND NO-MILD DYSP", "code_information": [{"code": "3450F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DZ NOT ASES, NO RSN", "code_information": [{"code": "M1006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DermOtic (FLUOCINOLONE ACE) OTIC 0.01%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001084", "type": "CDM"}, {"code": "45802000910", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "DermaBind FM, per square centimeter", "code_information": [{"code": "Q4313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dermacyte AC matrix amniotic membrane allograft, per square centimeter", "code_information": [{"code": "Q4343", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dermatological care MIPS value pathway", "code_information": [{"code": "M1421", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dexamethasone (Hemady), oral, 0.25 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Diflucan Oral Tablet 150MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002823", "type": "CDM"}, {"code": "57237000511", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 16.92, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Docking station for oral dev", "code_information": [{"code": "K1037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Documentation of medical reason(s) for not performing the PD-L1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize ", "code_information": [{"code": "M1414", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical re", "code_information": [{"code": "M1378", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one metho", "code_information": [{"code": "M1392", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Documentation of patient reasons for patients who were not seen for the second PAM survey (e.g., less than four months between baseline PAM assessment and follow-up", "code_information": [{"code": "M1385", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dronabinol (Syndros), 0.1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "code_information": [{"code": "Q0155", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Drug metabolism (adverse drug reactions and drug response), genotyping of 16 genes (ie, ABCG2, CYP2B6, CYP2C9, CYP2C19, CYP2C, CYP2D6, CYP3A5, CYP4F2, DPYD, G6PD, GGCX, NUDT15, SLCO1B1, TPMT, UGT1A1, VKORC1), reported as metabolizer status and transporter", "code_information": [{"code": "533U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Drug metabolism, psychiatry (eg, major depressive disorder, general anxiety disorder, attention deficit hyperactivity disorder [ADHD], schizophrenia), whole blood, buccal swab, and pharmacogenomic genotyping of 14 genes and CYP2D6 copy number variant anal", "code_information": [{"code": "476U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Drug metabolism, psychiatry (eg, major depressive disorder, general anxiety disorder, attention deficit hyperactivity disorder [ADHD], schizophrenia), whole blood, buccal swab, and pharmacogenomic genotyping of 14 genes and CYP2D6 copy number variant anal", "code_information": [{"code": "477U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Drug metabolism, whole blood, pharmacogenomic genotyping of 40 genes and CYP2D6 copy number variant analysis, reported as metabolizer status", "code_information": [{"code": "516U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dual layer Amnio Burgeon X-Membrane, per square centimeter", "code_information": [{"code": "Q4366", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DuoAmnion, per square centimeter", "code_information": [{"code": "Q4327", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Duplex scan of hemodialysis fistula, computer-aided, limited (volume flow, diameter, and depth, including only body of fistula)", "code_information": [{"code": "876T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable ankle extension only device, includes soft interface material", "code_information": [{"code": "E1822", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable ankle flexion only device, includes soft interface material", "code_information": [{"code": "E1823", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable elbow extension only device, includes soft interface material", "code_information": [{"code": "E1803", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable elbow flexion only device, includes soft interface material", "code_information": [{"code": "E1804", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable finger extension only device, includes soft interface material", "code_information": [{"code": "E1826", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable finger flexion only device, includes soft interface material", "code_information": [{"code": "E1827", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable knee extension only device, includes soft interface material", "code_information": [{"code": "E1813", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable knee flexion only device, includes soft interface material", "code_information": [{"code": "E1814", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable toe extension only device, includes soft interface material", "code_information": [{"code": "E1828", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable toe flexion only device, includes soft interface material", "code_information": [{"code": "E1829", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable wrist extension only device, includes soft interface material", "code_information": [{"code": "E1807", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dynamic adjustable wrist flexion only device, includes soft interface material", "code_information": [{"code": "E1808", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "E COLI 0157 AG IA", "code_information": [{"code": "87335", "type": "CPT"}], "standard_charges": [{"minimum": 14.56, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "E STIM PADS", "code_information": [{"code": "3000169", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "E-Graft, per square centimeter", "code_information": [{"code": "Q4318", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EACH ADDTNL CAST POST", "code_information": [{"code": "D2953", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EACH ADDTNL PREFAB POST", "code_information": [{"code": "D2957", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EAR AND THROAT EXAMINATION", "code_information": [{"code": "92502", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EAR CARTILAGE GRAFT", "code_information": [{"code": "21235", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EAR IMPRESSION", "code_information": [{"code": "V5275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EAR MICROSCOPY EXAMINATION", "code_information": [{"code": "92504", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EAR MOLD/INSERT", "code_information": [{"code": "V5264", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EAR MOLD/INSERT, DISP", "code_information": [{"code": "V5265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EAR PROTECTOR EVALUATION", "code_information": [{"code": "92596", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EAR PROTECTOR FOR NASAL CANNULA", "code_information": [{"code": "3001381", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EAR WAX REMOVAL AID", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000636", "type": "CDM"}, {"code": "78112073623", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 18.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [{"code": "147", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [{"code": "146", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "148", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EARDRUM REVISION", "code_information": [{"code": "69450", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EARLY IND/DELIVERY", "code_information": [{"code": "G9356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EASY REACH REACHER", "code_information": [{"code": "3000170", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EB THERAPY PRESCRIBED", "code_information": [{"code": "M1227", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EBV ANTIBODY PROFILE", "code_information": [{"code": "86309", "type": "CPT"}, {"code": "1000220", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.44, "maximum": 34.47, "gross_charge": 38.31, "discounted_cash": 54.17, "estimated_discounted_cash": 38.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 34.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECALLANTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1290", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93224", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93226", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93227", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECG RECORD/REVIEW", "code_information": [{"code": "93268", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECG/MONITORING AND ANALYSIS", "code_information": [{"code": "93271", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECG/REVIEW INTERPRET ONLY", "code_information": [{"code": "93272", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECG/SIGNAL-AVERAGED", "code_information": [{"code": "93278", "type": "CPT"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76516", "type": "CPT"}], "standard_charges": [{"minimum": 58.96, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76519", "type": "CPT"}], "standard_charges": [{"minimum": 85.0, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76529", "type": "CPT"}], "standard_charges": [{"minimum": 108.39, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 108.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE THICKNESS", "code_information": [{"code": "76514", "type": "CPT"}], "standard_charges": [{"minimum": 14.87, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76825", "type": "CPT"}], "standard_charges": [{"minimum": 324.42, "maximum": 337.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 337.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76826", "type": "CPT"}], "standard_charges": [{"minimum": 202.32, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 202.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76827", "type": "CPT"}], "standard_charges": [{"minimum": 90.62, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76828", "type": "CPT"}], "standard_charges": [{"minimum": 64.38, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 64.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF HEAD", "code_information": [{"code": "76506", "type": "CPT"}], "standard_charges": [{"minimum": 147.35, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 147.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM UTERUS", "code_information": [{"code": "76831", "type": "CPT"}], "standard_charges": [{"minimum": 149.46, "maximum": 149.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 149.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO EXAMINATION PROCEDURE", "code_information": [{"code": "76999", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDANCE RADIOTHERAPY", "code_information": [{"code": "76965", "type": "CPT"}], "standard_charges": [{"minimum": 120.35, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 120.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDANCE RADIOTHERAPY", "code_information": [{"code": "G6001", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.23, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR AMNIOCENTESIS", "code_information": [{"code": "76946", "type": "CPT"}], "standard_charges": [{"minimum": 41.43, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR ARTERY REPAIR", "code_information": [{"code": "76936", "type": "CPT"}], "standard_charges": [{"minimum": 336.06, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 336.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR HEART BIOPSY", "code_information": [{"code": "76932", "type": "CPT"}], "standard_charges": [{"minimum": 121.6, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 121.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR TRANSFUSION", "code_information": [{"code": "76941", "type": "CPT"}], "standard_charges": [{"minimum": 152.4, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 152.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE OVA ASPIRATION", "code_information": [{"code": "76948", "type": "CPT"}], "standard_charges": [{"minimum": 102.7, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 102.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE VILLUS SAMPLING", "code_information": [{"code": "76945", "type": "CPT"}], "standard_charges": [{"minimum": 111.94, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93312", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93313", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93314", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93315", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93316", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93317", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL (TEE)", "code_information": [{"code": "93355", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL INTRAOP", "code_information": [{"code": "93318", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93303", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHOCARDIOGRAPHY CONTRAST", "code_information": [{"code": "A9700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECHOSCLEROTHERAPY", "code_information": [{"code": "S2202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [{"code": "3", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT ARTERY", "code_information": [{"code": "33949", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT-VENOUS", "code_information": [{"code": "33948", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION ARTERY", "code_information": [{"code": "33947", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION VENOUS", "code_information": [{"code": "33946", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33955", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33956", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33951", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33952", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33953", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33954", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33957", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33958", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33959", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33962", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33963", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33964", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33985", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33986", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33965", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33969", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33966", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33984", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECOG IMPLTD BRN NPGT <30 D", "code_information": [{"code": "95836", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECOTRIN (ASPIRIN) TAB : 325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000175", "type": "CDM"}, {"code": "49692090377", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ECP CILIARY BODY DESTRUCTION", "code_information": [{"code": "66711", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECT PROVIDED", "code_information": [{"code": "4066F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD GRP PER SESSION", "code_information": [{"code": "G0421", "type": "HCPCS"}], "standard_charges": [{"minimum": 146.67, "maximum": 146.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 146.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD IND PER SESSION", "code_information": [{"code": "G0420", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EDETATE CALCIUM DISODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0600", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EDETATE DISODIUM PER 150 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EE&MJ BSC PRTN ELISA EST DEV", "code_information": [{"code": "95U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG 41-60 MINUTES", "code_information": [{"code": "95812", "type": "CPT"}], "standard_charges": [{"minimum": 1616.78, "maximum": 1616.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1616.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG AWAKE AND ASLEEP", "code_information": [{"code": "95819", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG AWAKE AND DROWSY", "code_information": [{"code": "95816", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG CEREBRAL DEATH ONLY", "code_information": [{"code": "95824", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG COMA OR SLEEP ONLY", "code_information": [{"code": "95822", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG CONT REC W/VID EEG TECH", "code_information": [{"code": "95700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG DIGITAL ANALYSIS", "code_information": [{"code": "95957", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG DURING SURGERY", "code_information": [{"code": "95955", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG EXTND MNTR 61-119 MIN", "code_information": [{"code": "95813", "type": "CPT"}], "standard_charges": [{"minimum": 1616.78, "maximum": 1616.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1616.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG MONITORING/FUNCTION TEST", "code_information": [{"code": "95958", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG MONITORING/GIVING DRUGS", "code_information": [{"code": "95954", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG ORDERED RVWD REQSTD", "code_information": [{"code": "3650F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP EA INCR W/VEEG", "code_information": [{"code": "95720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>36<60 HR W/O VID", "code_information": [{"code": "95721", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>36<60 HR W/VEEG", "code_information": [{"code": "95722", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>60<84 HR W/O VID", "code_information": [{"code": "95723", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>60<84 HR W/VEEG", "code_information": [{"code": "95724", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>84 HR W/O VID", "code_information": [{"code": "95725", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>84 HR W/VEEG", "code_information": [{"code": "95726", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/O VID", "code_information": [{"code": "95717", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/VEEG", "code_information": [{"code": "95718", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP EA INCR W/O VID", "code_information": [{"code": "95719", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12 HR UNMNTR", "code_information": [{"code": "95705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12HR CONT MNTR", "code_information": [{"code": "95707", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR CONT", "code_information": [{"code": "95710", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR INTMT", "code_information": [{"code": "95709", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG WO VID 2-12HR INTMT MNTR", "code_information": [{"code": "95706", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EEG WO VID EA 12-26HR UNMNTR", "code_information": [{"code": "95708", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EF ADULT FLUIDS AND ELECTRO", "code_information": [{"code": "B4102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EF PED CALORIC DENSE>/=0.7KC", "code_information": [{"code": "B4160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EF PED COMPLETE INTACT NUT", "code_information": [{"code": "B4158", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EF PED COMPLETE SOY BASED", "code_information": [{"code": "B4159", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EF PED FLUID AND ELECTROLYTE", "code_information": [{"code": "B4103", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EF PED HYDROLYZED/AMINO ACID", "code_information": [{"code": "B4161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EF PED SPECMETABOLIC INHERIT", "code_information": [{"code": "B4162", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EF SPECIAL METABOLIC INHERIT", "code_information": [{"code": "B4157", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EFFERDENT DENTURE CLEANSER", "code_information": [{"code": "3000013", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EFFEXOR (VENLAFAXINE HCL) 50MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002593", "type": "CDM"}, {"code": "57237017401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EFFEXOR (VENLAFAXINE) CAP 37.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000321", "type": "CDM"}, {"code": "68084069801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EFFEXOR XR (VENLAFAXINE) CAP 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000186", "type": "CDM"}, {"code": "65862052830", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EFFEXOR-XR (VENLAFAXINE ER) 150MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003675", "type": "CDM"}, {"code": "65862069730", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 58.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EFIPRES (EPHEDRINE SULF) 50MG/ ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1071", "type": "HCPCS"}, {"code": "7200072", "type": "CDM"}, {"code": "66758000802", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 12.11, "maximum": 19.12, "gross_charge": 21.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD BALLOON DIL ESOPH30 MM/>", "code_information": [{"code": "43233", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD BIOPSY SINGLE/MULTIPLE", "code_information": [{"code": "43239", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD CAUTERY TUMOR POLYP", "code_information": [{"code": "43250", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD CONTROL BLEEDING ANY", "code_information": [{"code": "43255", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD DIAGNOSTIC BRUSH WASH", "code_information": [{"code": "43235", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD DILATE STRICTURE", "code_information": [{"code": "43245", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD ENDO MUCOSAL RESECTION", "code_information": [{"code": "43254", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD ENDOSCOPIC STENT PLACE", "code_information": [{"code": "43266", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD ESOPHAGOGASTRC FNDOPLSTY", "code_information": [{"code": "43210", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL BX 1/MLT", "code_information": [{"code": "653T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL DX BR/WA", "code_information": [{"code": "652T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL TUBE/CATH", "code_information": [{"code": "654T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL DPLMNT BALO", "code_information": [{"code": "43290", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL RMVL BALO", "code_information": [{"code": "43291", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD GUIDE WIRE INSERTION", "code_information": [{"code": "43248", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD INJECTION VARICES", "code_information": [{"code": "43243", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD LESION ABLATION", "code_information": [{"code": "43270", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43252", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43246", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE FOREIGN BODY", "code_information": [{"code": "43247", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE LESION SNARE", "code_information": [{"code": "43251", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD TUBE/CATH INSERTION", "code_information": [{"code": "43241", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD US EXAM DUODENUM/JEJUNUM", "code_information": [{"code": "43259", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43238", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43242", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD US TRANSMURAL INJXN/MARK", "code_information": [{"code": "43253", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD VARICES LIGATION", "code_information": [{"code": "43244", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD VOL ADJMT BARIATRIC BALO", "code_information": [{"code": "813T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD W/THRML TXMNT GERD", "code_information": [{"code": "43257", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGD W/TRANSMURAL DRAIN CYST", "code_information": [{"code": "43240", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGFR GENE COM VARIANTS", "code_information": [{"code": "81235", "type": "CPT"}], "standard_charges": [{"minimum": 373.27, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 373.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EGGCRATE MATTRESS DELUXE", "code_information": [{"code": "3000033", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 34.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EHRLICHA CHAFFEENSIS AMP PRB", "code_information": [{"code": "87484", "type": "CPT"}], "standard_charges": [{"minimum": 41.06, "maximum": 41.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA ANTIBODY", "code_information": [{"code": "86666", "type": "CPT"}], "standard_charges": [{"minimum": 11.71, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EIA HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0432", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EKG - TRACE ONLY", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "6000001", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 84.11, "maximum": 151.09, "gross_charge": 167.88, "discounted_cash": 54.17, "estimated_discounted_cash": 176.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 151.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 95.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG FOR INITIAL PREVENT EXAM", "code_information": [{"code": "G0403", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EKG HOLTER MONITOR HOOK UP READ/DISC", "code_information": [{"code": "93225", "type": "CPT"}, {"code": "6000003", "type": "CDM"}, {"code": "731", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG INTERPRET & REPORT PREVE", "code_information": [{"code": "G0405", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EKG RHYTHM STRIP", "code_information": [{"code": "93041", "type": "CPT"}, {"code": "6000002", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 84.11, "maximum": 151.09, "gross_charge": 167.88, "discounted_cash": 54.17, "estimated_discounted_cash": 70.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 151.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 95.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG TRACING FOR INITIAL PREV", "code_information": [{"code": "G0404", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EL-1 FECAL QUAL/SEMIQ", "code_information": [{"code": "82656", "type": "CPT"}], "standard_charges": [{"minimum": 13.26, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EL-1 FECAL QUANTITATIVE", "code_information": [{"code": "82653", "type": "CPT"}], "standard_charges": [{"minimum": 26.42, "maximum": 26.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELASTIC BANDAGE 2 W/VELCRO", "code_information": [{"code": "3000019", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELASTIC BANDAGE 3 W/VELCRO", "code_information": [{"code": "3000020", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 9.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELASTIC BANDAGE 4 W/VELCRO", "code_information": [{"code": "3000021", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELASTIC BANDAGE 6 W/VELCRO", "code_information": [{"code": "3000022", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELAVIL (AMITRIPTYLINE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000028", "type": "CDM"}, {"code": "50268003715", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELAVIL (AMITRIPTYLINE) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000029", "type": "CDM"}, {"code": "70756020211", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELAVIL (NF-AMITRIPTYLINE HCL) 100MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001413", "type": "CDM"}, {"code": "72888007101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY", "code_information": [{"code": "29830", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29834", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29835", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29836", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29837", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29838", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELD MAL SCRN POS NO PLAN", "code_information": [{"code": "G8735", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELD MALTREATMENT NOT DOC", "code_information": [{"code": "G8535", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALY CPX IINS SP/SAC NRV", "code_information": [{"code": "789T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALY SMP IINS SP/SAC NRV", "code_information": [{"code": "788T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS CPLX PRGRMG IINS", "code_information": [{"code": "590T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS SMPL PRGRMG IINS", "code_information": [{"code": "589T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC IMPD SPECTRSC 1+SKN LES", "code_information": [{"code": "658T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC MED COMP DEV, NOC", "code_information": [{"code": "T1505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC STIM OTHER THAN WOUND", "code_information": [{"code": "G0283", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "estimated_discounted_cash": 41.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC STIM UNATTEND FOR PRESS", "code_information": [{"code": "G0281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECT STIM WOUND CARE NOT PD", "code_information": [{"code": "G0282", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTIVE SURGERY", "code_information": [{"code": "G9643", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRIC BREAST PUMP", "code_information": [{"code": "E0603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRIC STIMULATION THERAPY", "code_information": [{"code": "97014", "type": "CPT"}], "standard_charges": [{"minimum": 11.84, "maximum": 103.18, "discounted_cash": 54.17, "estimated_discounted_cash": 41.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRIC WOUND TREATMENT DEV", "code_information": [{"code": "E0769", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20974", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20975", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TEST ONE", "code_information": [{"code": "92594", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TST BOTH", "code_information": [{"code": "92595", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRO-OCULOGRAPHY W/I&R", "code_information": [{"code": "92270", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRO-UROFLOWMETRY FIRST", "code_information": [{"code": "51741", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM COMPLETE", "code_information": [{"code": "93000", "type": "CPT"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM REPORT", "code_information": [{"code": "93010", "type": "CPT"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROCOCHLEOGRAPHY", "code_information": [{"code": "92584", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROCONVULSIVE THERAPY", "code_information": [{"code": "90870", "type": "CPT"}], "standard_charges": [{"minimum": 1557.65, "maximum": 1557.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1557.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRODE PACING/DEFIB QUIK COMBO PAK", "code_information": [{"code": "3001281", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 179.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELECTRODE PACING/DEFIB QUIK COMBO PED", "code_information": [{"code": "3001439", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 338.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELECTRODE STIM BRAIN ADD-ON", "code_information": [{"code": "95962", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRODE STIMULATION BRAIN", "code_information": [{"code": "95961", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRODIAG POLYNEURO 6 MN", "code_information": [{"code": "3751F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROEJACULATION", "code_information": [{"code": "55870", "type": "CPT"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY", "code_information": [{"code": "91132", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY W/TEST", "code_information": [{"code": "91133", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROLYTE PANEL", "code_information": [{"code": "80051", "type": "CPT"}, {"code": "1000153", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.06, "maximum": 37.36, "gross_charge": 41.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 33.21, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 37.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 23.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROMAGNETIC THERAPY ONC", "code_information": [{"code": "G0295", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROMAGNTIC TX FOR ULCERS", "code_information": [{"code": "G0329", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROMYOGRAPH BIOFEEDBACK", "code_information": [{"code": "E0746", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRON BEAM COMPUTED TOMOG", "code_information": [{"code": "S8092", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.87, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRON MICROSCOPY", "code_information": [{"code": "D0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.12, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRON MICROSCOPY DX", "code_information": [{"code": "88348", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 480.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 480.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRONIC SALIVARY REFLEX S", "code_information": [{"code": "E0755", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRONIC SPIROMETER", "code_information": [{"code": "E0487", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHORETIC TEST", "code_information": [{"code": "82664", "type": "CPT"}], "standard_charges": [{"minimum": 70.73, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 70.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYS MAP 3D ADD-ON", "code_information": [{"code": "93613", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGIC STUDY", "code_information": [{"code": "93624", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93619", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93620", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93621", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93622", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93641", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93642", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93644", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEV BP PLAN OF CARE DOCD", "code_information": [{"code": "513F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELIQUIS (APIXABAN) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001019", "type": "CDM"}, {"code": "00003089331", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELIQUIS (APIXABAN) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001005", "type": "CDM"}, {"code": "00003089431", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELISA HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0433", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELLIOTTS B SOLUTION PER ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELMIRON (NF-ELMIRON) CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "47", "type": "CDM"}, {"code": "50458009801", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.42, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELOCON (MOMETASONE) 0.1% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000179", "type": "CDM"}, {"code": "45802025735", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 17.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELOCON OINTMENT 15G", "code_information": [{"code": "3000172", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ELOSULFASE ALFA, INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1322", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EM 5 PERCENT WL", "code_information": [{"code": "G9880", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EM 9 PERCENT WL", "code_information": [{"code": "G9881", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EM BRIDGE PAYMENT", "code_information": [{"code": "G9890", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EM SESSION REPORTING", "code_information": [{"code": "G9891", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMA EACH IG CLASS", "code_information": [{"code": "86231", "type": "CPT"}], "standard_charges": [{"minimum": 13.9, "maximum": 13.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMBEDDED IP CATH EXIT-SITE", "code_information": [{"code": "49436", "type": "CPT"}], "standard_charges": [{"minimum": 637.4, "maximum": 637.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 637.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMBOLIZATION DOC SEPARATLY", "code_information": [{"code": "G9962", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMBOLIZATION NOT DOC SEPARAT", "code_information": [{"code": "G9963", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMBOLIZATION PROTECT SYST", "code_information": [{"code": "C1884", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMBRYO HATCHING", "code_information": [{"code": "89253", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 225.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMER RESPONSE SYS INSTAL&TST", "code_information": [{"code": "S5160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMER RSPNS SYS SERV PERMONTH", "code_information": [{"code": "S5161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMER RSPNS SYSTEM PURCHASE", "code_information": [{"code": "S5162", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMERGE CASES", "code_information": [{"code": "M1142", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMERGE MATRIX, PER SQ CM", "code_information": [{"code": "Q4297", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMERGENCY MED SS", "code_information": [{"code": "G4003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMERGENCY TRACHEOTOMY", "code_information": [{"code": "D7990", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMERY BOARDS", "code_information": [{"code": "3000173", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EMESIS BAG", "code_information": [{"code": "3001369", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EMESIS BASIN", "code_information": [{"code": "3000023", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EMLA (LIDOCAINE-PRILOCAINE) CREAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004303", "type": "CDM"}, {"code": "00168035730", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EMPIRIC ANTIBIOTIC RX", "code_information": [{"code": "4045F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENALAPRILAT DIHYDRATE INJ 1.25MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000182", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENAMEL MICROABRASION", "code_information": [{"code": "D9970", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENCEPHALITIS CALIFORN ANTBDY", "code_information": [{"code": "86651", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS EAST EQNE ANBDY", "code_information": [{"code": "86652", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS ST LOUIS ANTBODY", "code_information": [{"code": "86653", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS WEST EQNE ANTBDY", "code_information": [{"code": "86654", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "END BAC 11 DISINFECTANT", "code_information": [{"code": "80000832", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "END OF LIFE COUNSELING", "code_information": [{"code": "S0257", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "END THXPY, ANTERIOR TOOTH", "code_information": [{"code": "D3310", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "END THXPY, MOLAR TOOTH", "code_information": [{"code": "D3330", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "END THXPY, PREMOLAR TOOTH", "code_information": [{"code": "D3320", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO ABL PROC YR PREV IND DT", "code_information": [{"code": "G9822", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO ASSAY SEVEN ANAL", "code_information": [{"code": "81506", "type": "CPT"}], "standard_charges": [{"minimum": 79.26, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 79.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43261", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43262", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO OUTLET RESTRICT W/TUBE", "code_information": [{"code": "C9785", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO SLEEVE GASTRO W/TUBE", "code_information": [{"code": "C9784", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO SMPL/HYST BX RES DOC", "code_information": [{"code": "G9823", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO SMPL/HYST BX RES NO DOC", "code_information": [{"code": "G9824", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO US-GUIDE HEP PORTO GRAD", "code_information": [{"code": "C9768", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO, COLON, RETRO IMAGING", "code_information": [{"code": "C1749", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO, SINGLE, PULMONARY", "code_information": [{"code": "C1601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO, SINGLE, URINARY TRACT", "code_information": [{"code": "C1747", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOCERV CURETTAGE W/SCOPE", "code_information": [{"code": "57456", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOCERVICAL CURETTAGE", "code_information": [{"code": "57505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH CC", "code_information": [{"code": "644", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [{"code": "643", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "645", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ENDOCRINOLOGY SS", "code_information": [{"code": "G4004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDODONTIC ENDOSSEOUS IMPLAN", "code_information": [{"code": "D3460", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDODONTIC PROCEDURE", "code_information": [{"code": "D3999", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOFORM 2X2", "code_information": [{"code": "3001418", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 148.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX BILIARY TREE", "code_information": [{"code": "47543", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX URTR RNL PLVS", "code_information": [{"code": "50606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C 1ST", "code_information": [{"code": "92978", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C EA", "code_information": [{"code": "92979", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOMETR ABLATE THERMAL", "code_information": [{"code": "58353", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL CRYOABLATION", "code_information": [{"code": "58356", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPE, SINGLE, UGI", "code_information": [{"code": "C1748", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC INJECTION/IMPLANT", "code_information": [{"code": "51715", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC PANCREATOSCOPY", "code_information": [{"code": "43273", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC US EXAM ESOPH", "code_information": [{"code": "43237", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC VEIN HARVEST", "code_information": [{"code": "33508", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY BOWEL POUCH/BIOP", "code_information": [{"code": "44386", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY LIGATE PERF VEINS", "code_information": [{"code": "37500", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY MAXILLARY SINUS", "code_information": [{"code": "31267", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF BOWEL POUCH", "code_information": [{"code": "44385", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50951", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50953", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) I&R", "code_information": [{"code": "92613", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) VID", "code_information": [{"code": "92612", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "estimated_discounted_cash": 750.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOSTEAL IMPLANT", "code_information": [{"code": "D6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOTRACH INTUBATION TECH", "code_information": [{"code": "31500", "type": "CPT"}, {"code": "11000037", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 309.54, "maximum": 2899.78, "gross_charge": 543.06, "discounted_cash": 54.17, "estimated_discounted_cash": 543.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 407.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 434.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2899.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 488.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 309.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVAS ILIAC A DEVICE ADDON", "code_information": [{"code": "34808", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVAS NON-CARDIAC ABL CATH", "code_information": [{"code": "C1888", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH DELAYED", "code_information": [{"code": "33886", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH TAA ADD-ON", "code_information": [{"code": "33884", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR INCL SUBCL", "code_information": [{"code": "33880", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR W/O SUBCL", "code_information": [{"code": "33881", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TEMPORY VESSEL OCCL", "code_information": [{"code": "61623", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 1 GRAFT", "code_information": [{"code": "34841", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 2 GRAFT", "code_information": [{"code": "34842", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 3 GRAFT", "code_information": [{"code": "34843", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 4 GRAFT", "code_information": [{"code": "34844", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [{"code": "266", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [{"code": "267", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES 1ST", "code_information": [{"code": "36482", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES SBSQ", "code_information": [{"code": "36483", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER 1ST VEIN", "code_information": [{"code": "36478", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER VEIN ADDON", "code_information": [{"code": "36479", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM 1ST VEIN", "code_information": [{"code": "36473", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM ADD-ON", "code_information": [{"code": "36474", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF 1ST VEIN", "code_information": [{"code": "36475", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [{"code": "36476", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENEMA BAG SET W/SOAP", "code_information": [{"code": "3000024", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENEMA TUBE ANY TYPE REPL", "code_information": [{"code": "A4457", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENFUVIRTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1324", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENGERIX B (HEPATITIS B) 20MCG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "90740", "type": "CPT"}, {"code": "7000183", "type": "CDM"}, {"code": "58160082111", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 42.0, "maximum": 350.17, "gross_charge": 73.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 58.96, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 66.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENLUXTRA DRSG 4X4", "code_information": [{"code": "3001408", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENLUXTRA DRSG 6X6", "code_information": [{"code": "3001413", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 81.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE CHOCOLATE", "code_information": [{"code": "80001196", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE CLEAR MIXED BERRY", "code_information": [{"code": "80001219", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE ENLIVE VANILLA", "code_information": [{"code": "80001253", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE PLUS CHOCOLATE", "code_information": [{"code": "80001195", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE PLUS STRAWBERRY", "code_information": [{"code": "80001199", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE PLUS VANILLA", "code_information": [{"code": "80001194", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE PUDDING CHOCOLATE", "code_information": [{"code": "80001221", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE PUDDING VANILLA", "code_information": [{"code": "80001191", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE STRAWBERRY", "code_information": [{"code": "80001200", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENSURE VANILLA", "code_information": [{"code": "80001197", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST DISPR AG IA", "code_information": [{"code": "87336", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST GROUP AG IA", "code_information": [{"code": "87337", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERAL FEED ELASTOMER DAILY", "code_information": [{"code": "B4148", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERAL SUPP NOT OTHERWISE C", "code_information": [{"code": "B9998", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CADAVER DONOR", "code_information": [{"code": "44132", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CONG ADD-ON", "code_information": [{"code": "44128", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY LIVE DONOR", "code_information": [{"code": "44133", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/O TAPER CONG", "code_information": [{"code": "44126", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/TAPER CONG", "code_information": [{"code": "44127", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERIC PATHOGEN PANEL", "code_information": [{"code": "87045", "type": "CPT"}, {"code": "1099031", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.86, "maximum": 270.0, "gross_charge": 300.0, "discounted_cash": 54.17, "estimated_discounted_cash": 238.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 171.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROSTOMAL THERAPY BY A RE", "code_information": [{"code": "S9474", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY", "code_information": [{"code": "86658", "type": "CPT"}], "standard_charges": [{"minimum": 14.98, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY DFA", "code_information": [{"code": "87267", "type": "CPT"}], "standard_charges": [{"minimum": 15.43, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS REAL-TIME PCR", "code_information": [{"code": "87498", "type": "CPT"}, {"code": "1000963", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 40.35, "maximum": 176.4, "gross_charge": 196.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 156.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 111.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTOCORT (BUDESONIDE) ER 3MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001137", "type": "CDM"}, {"code": "65162077810", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENTRESTO 24MG-26MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003912", "type": "CDM"}, {"code": "00078065920", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 43.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENTRESTO 49MG-51MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002395", "type": "CDM"}, {"code": "00078077720", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 33.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENTRESTO 97MG-103MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001121", "type": "CDM"}, {"code": "00078069620", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 27.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENULOSE (LACTULOSE) SOL 10GM/15ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000264", "type": "CDM"}, {"code": "00116400515", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENURESIS ALARM", "code_information": [{"code": "S8270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENVELOPES BUBBLE WRAP CUSHIONED MAILERS", "code_information": [{"code": "80000919", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENVELOPES WINDOW #9 W/LOGO", "code_information": [{"code": "80000488", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ENVERSE, PER SQ CM", "code_information": [{"code": "Q4258", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENVIRONMENTAL MANIPULATION", "code_information": [{"code": "90882", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENZYMATIC CARBONATE", "code_information": [{"code": "82374", "type": "CPT"}, {"code": "1000236", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.61, "maximum": 26.05, "gross_charge": 28.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME CARTRIDGE ENTERAL NUT", "code_information": [{"code": "B4105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY", "code_information": [{"code": "82657", "type": "CPT"}], "standard_charges": [{"minimum": 25.5, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY RA", "code_information": [{"code": "82658", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 50.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENZYME HISTOCHEMISTRY", "code_information": [{"code": "88319", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 147.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 147.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EOM MEOS PAYMENT", "code_information": [{"code": "M0010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EOSINOPHIL - BLOOD", "code_information": [{"code": "85048", "type": "CPT"}, {"code": "1000703", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.92, "maximum": 17.93, "gross_charge": 15.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EOSINOPHIL - URINE", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "1000625", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 4.91, "maximum": 23.08, "gross_charge": 25.26, "discounted_cash": 54.17, "estimated_discounted_cash": 25.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EOSINOPHIL BLOOD COUNT", "code_information": [{"code": "S3630", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EP CARDIO SS", "code_information": [{"code": "G4002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPAP NASAL VALVE", "code_information": [{"code": "A7049", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPHYS EVAL ICDS SS", "code_information": [{"code": "577T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPI ETIOL SYND RVWD AND DOCD", "code_information": [{"code": "1205F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPICORD 1 SQ CM", "code_information": [{"code": "Q4187", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT F/N/HF/G ADDL", "code_information": [{"code": "15116", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT FACE/NCK/HF/G", "code_information": [{"code": "15115", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT T/A/L ADD-ON", "code_information": [{"code": "15111", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT TRNK/ARM/LEG", "code_information": [{"code": "15110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIDURAL LYSIS MULT SESSIONS", "code_information": [{"code": "62263", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIDURAL LYSIS ON SINGLE DAY", "code_information": [{"code": "62264", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIEFFECT, PER SQ CM", "code_information": [{"code": "Q4278", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIFIX 1 SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPIFIX, INJ, 1MG", "code_information": [{"code": "Q4145", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPILEPSY GEN SEQ ALYS PANEL", "code_information": [{"code": "81419", "type": "CPT"}], "standard_charges": [{"minimum": 2815.84, "maximum": 2815.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2815.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPISIOTOMY OR VAGINAL REPAIR", "code_information": [{"code": "59300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITH MCC", "code_information": [{"code": "150", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITHOUT MCC", "code_information": [{"code": "151", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EPOETIN ALFA, 100 UNITS ESRD", "code_information": [{"code": "Q4081", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPOETIN BETA ESRD USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0887", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPOETIN BETA NON ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0888", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPOPROSTENOL DILUTANT", "code_information": [{"code": "S0155", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPOPROSTENOL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1325", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPSD BK PAIN FOR 12 WKS/<", "code_information": [{"code": "1136F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPSD BK PAIN FOR 6 WKS/<", "code_information": [{"code": "1134F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPSD BK PAIN FOR >12 WKS", "code_information": [{"code": "1137F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPSD BK PAIN FOR >6 WKS", "code_information": [{"code": "1135F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ER AND IP HOSP <2 IN 12 MOS", "code_information": [{"code": "G9521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ER LEVEL FIVE", "code_information": [{"code": "99285", "type": "CPT"}, {"code": "11000038", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 890.65, "maximum": 1406.29, "gross_charge": 1562.55, "discounted_cash": 54.17, "estimated_discounted_cash": 1728.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1171.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1250.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1406.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 890.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER LEVEL FOUR", "code_information": [{"code": "99284", "type": "CPT"}, {"code": "11000039", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 607.95, "maximum": 959.93, "gross_charge": 1066.59, "discounted_cash": 54.17, "estimated_discounted_cash": 1207.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 799.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 853.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 959.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 607.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER LEVEL ONE", "code_information": [{"code": "99281", "type": "CPT"}, {"code": "11000040", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 117.4, "maximum": 185.38, "gross_charge": 205.98, "discounted_cash": 54.17, "estimated_discounted_cash": 205.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 154.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 164.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 185.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 117.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER LEVEL THREE", "code_information": [{"code": "99283", "type": "CPT"}, {"code": "11000041", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 374.66, "maximum": 591.57, "gross_charge": 657.3, "discounted_cash": 54.17, "estimated_discounted_cash": 747.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 492.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 525.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 591.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 374.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER LEVEL TWO", "code_information": [{"code": "99282", "type": "CPT"}, {"code": "11000042", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 213.15, "maximum": 336.55, "gross_charge": 373.95, "discounted_cash": 54.17, "estimated_discounted_cash": 477.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 280.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 299.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 336.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 213.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER+ OR PR+ BREAST CANCER", "code_information": [{"code": "3315F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ER- OR PR- BREAST CANCER", "code_information": [{"code": "3316F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ER/IP HOSP =/>2 IN 12 MOS", "code_information": [{"code": "G9522", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP DUCT STENT PLACEMENT", "code_information": [{"code": "43274", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP EA DUCT/AMPULLA DILATE", "code_information": [{"code": "43277", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP LESION ABLATE W/DILATE", "code_information": [{"code": "43278", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP LITHOTRIPSY CALCULI", "code_information": [{"code": "43265", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE DUCT CALCULI", "code_information": [{"code": "43264", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY DUCT", "code_information": [{"code": "43275", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY&ENDO", "code_information": [{"code": "C7560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP RMV CALC PANCREATOSCOPY", "code_information": [{"code": "C7544", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP SPHINCTER PRESSURE MEAS", "code_information": [{"code": "43263", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP STENT EXCHANGE W/DILATE", "code_information": [{"code": "43276", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/ PANCREATOSCOPY", "code_information": [{"code": "C7541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/BX & PANCREATOSCOPY", "code_information": [{"code": "C7542", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "397T", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "405U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/OTOMY, PANCREATOSCOPY", "code_information": [{"code": "C7543", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERCP W/SPECIMEN COLLECTION", "code_information": [{"code": "43260", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERGONOVINE MALEATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERIBULIN MESYLATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9179", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERWINAZE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9019", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERYTHRO LACTOBIONATE /500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}, {"code": "1000077", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 21.61, "maximum": 100.14, "gross_charge": 111.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 89.01, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 100.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 63.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESANO A, PER SQ CM", "code_information": [{"code": "Q4272", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESANO AAA, PER SQ CM", "code_information": [{"code": "Q4273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESANO AC, PER SQ CM", "code_information": [{"code": "Q4274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESANO ACA, PER SQ CM", "code_information": [{"code": "Q4275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESCHAROTOMY ADDL INCISION", "code_information": [{"code": "16036", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESCITALOPRAM OXALATE SOLN 5MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001037", "type": "CDM"}, {"code": "31722056924", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ESD ENDOSCOPY OR COLONOSCOPY", "code_information": [{"code": "C9779", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH BALLOON DISTENSION TST", "code_information": [{"code": "91040", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH BX RPRT W/DYSPL INFO", "code_information": [{"code": "3126F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH EGD DILATION <30 MM", "code_information": [{"code": "43249", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH ENDOSCOPY DILATION", "code_information": [{"code": "43226", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY LAP", "code_information": [{"code": "43327", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY THOR", "code_information": [{"code": "43328", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TEST > 1HR", "code_information": [{"code": "91038", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCTION TEST", "code_information": [{"code": "91037", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH LENGTHENING", "code_information": [{"code": "43338", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43206", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SCLEROSIS INJ", "code_information": [{"code": "43204", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SUBMUCOUS INJ", "code_information": [{"code": "43201", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAG MUC INTEG W/ESO EGD", "code_information": [{"code": "C9777", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY STUDY", "code_information": [{"code": "78258", "type": "CPT"}], "standard_charges": [{"minimum": 255.37, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 255.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93615", "type": "CPT"}], "standard_charges": [{"minimum": 19778.37, "maximum": 19778.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19778.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93616", "type": "CPT"}], "standard_charges": [{"minimum": 19778.37, "maximum": 19778.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19778.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [{"code": "391", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [{"code": "392", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 1192.05, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY ABDOMINAL", "code_information": [{"code": "43330", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY THORACIC", "code_information": [{"code": "43331", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOPLASTY CONGENITAL", "code_information": [{"code": "43313", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC DILATE BALLOON 30", "code_information": [{"code": "43214", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC FLEX TRNSN BIOPSY", "code_information": [{"code": "43198", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP MUCOSAL RESECT", "code_information": [{"code": "43211", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP STENT PLACEMENT", "code_information": [{"code": "43212", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP ULTRASOUND EXAM", "code_information": [{"code": "43231", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY BALLOON <30MM", "code_information": [{"code": "43220", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY CONTROL BLEED", "code_information": [{"code": "43227", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX BIOPSY", "code_information": [{"code": "43202", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX DX BRUSH", "code_information": [{"code": "43197", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX REMOVE FB", "code_information": [{"code": "43215", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEXIBLE BRUSH", "code_information": [{"code": "43200", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION ABLATE", "code_information": [{"code": "43229", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION REMOVAL", "code_information": [{"code": "43216", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RETRO BALLOON", "code_information": [{"code": "43213", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID BALLOON", "code_information": [{"code": "43195", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO", "code_information": [{"code": "43180", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO DX", "code_information": [{"code": "43191", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY SNARE LES REMV", "code_information": [{"code": "43217", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY W/US NEEDLE BX", "code_information": [{"code": "43232", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP GUIDE WIRE DILAT", "code_information": [{"code": "43196", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO BIOPSY", "code_information": [{"code": "43193", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO INJECT", "code_information": [{"code": "43192", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO REM FB", "code_information": [{"code": "43194", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS ENDOSCOPY/LIGATION", "code_information": [{"code": "43205", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS MOTILITY STUDY", "code_information": [{"code": "91010", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHGL MOTIL W/STIM/PERFUS", "code_information": [{"code": "91013", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESPHG DSTL 2/3 W/LAPS MOBLJ", "code_information": [{"code": "43287", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESPHG THRSC MOBLJ", "code_information": [{"code": "43288", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/LAPS MOBLJ", "code_information": [{"code": "43286", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/THRCM", "code_information": [{"code": "43112", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD DEMO BUNDLE LEVEL I", "code_information": [{"code": "G9013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD DEMO BUNDLE-LEVEL II", "code_information": [{"code": "G9014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 12-19", "code_information": [{"code": "90965", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 2-11", "code_information": [{"code": "90964", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 20+", "code_information": [{"code": "90966", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO <2YRS", "code_information": [{"code": "90963", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD ON DIALYSI DRUG/BIO NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3591", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO 20+", "code_information": [{"code": "90962", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO <2YRS", "code_information": [{"code": "90953", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VST P MO 12-19", "code_information": [{"code": "90959", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 2-3 VSTS P MO <2YR", "code_information": [{"code": "90952", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VISITS P MO <2YR", "code_information": [{"code": "90951", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VSTS P MO 2-11", "code_information": [{"code": "90954", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 1 VISIT P MO 2-11", "code_information": [{"code": "90956", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 12-19", "code_information": [{"code": "90958", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 2-11", "code_information": [{"code": "90955", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 20+", "code_information": [{"code": "90961", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VISITS P MO 20+", "code_information": [{"code": "90960", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VSTS P MO 12-19", "code_information": [{"code": "90957", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 12-19", "code_information": [{"code": "90969", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 2-11", "code_information": [{"code": "90968", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 20+", "code_information": [{"code": "90970", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT <2", "code_information": [{"code": "90967", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO AORTA", "code_information": [{"code": "36160", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO ARTERY", "code_information": [{"code": "36100", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62180", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62190", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62192", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62223", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTRACE (ESTRADIOL) 0.5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004327", "type": "CDM"}, {"code": "70954056410", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ESTRACE (ESTRADIOL) 1MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000720", "type": "CDM"}, {"code": "00555088604", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ESTRACE (ESTRADIOL) TAB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000226", "type": "CDM"}, {"code": "00555088702", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ESTRADIOL", "code_information": [{"code": "82670", "type": "CPT"}, {"code": "1000225", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 32.13, "maximum": 148.85, "gross_charge": 165.39, "discounted_cash": 54.17, "estimated_discounted_cash": 165.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 132.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 148.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 94.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL VALERATE 10 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTRIOL", "code_information": [{"code": "82677", "type": "CPT"}, {"code": "1000836", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 27.81, "maximum": 126.0, "gross_charge": 140.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGEN LEVEL", "code_information": [{"code": "82672", "type": "CPT"}, {"code": "1000128", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 24.96, "maximum": 115.53, "gross_charge": 128.37, "discounted_cash": 54.17, "estimated_discounted_cash": 128.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 102.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 115.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 73.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRONE", "code_information": [{"code": "82679", "type": "CPT"}, {"code": "1000835", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 28.69, "maximum": 130.5, "gross_charge": 145.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 82.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG 1ST WND", "code_information": [{"code": "512T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG EA ADDL", "code_information": [{"code": "513T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESW MUSCSKEL SYS NOS", "code_information": [{"code": "101T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESW PHY ANES LAT HMRL EPCNDL", "code_information": [{"code": "102T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESWL FOR GALLSTONES", "code_information": [{"code": "S9034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ET TUBE INTRODUCER BOUGIE", "code_information": [{"code": "3001387", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ETANERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1438", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ETH ESTR AND ETON MONTHLY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7295", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ETHANOLAMINE OLEATE 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1430", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ETIDRONATE DISODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1436", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ETONOGESTREL IMPLANT SYSTEM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7307", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ETOPOSIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ETOPOSIDE ORAL 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8560", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EUCERIN CREAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000186", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EUFLEXXA INJ PER DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7323", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EUGLOBULIN LYSIS", "code_information": [{"code": "85360", "type": "CPT"}], "standard_charges": [{"minimum": 9.67, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EURAX 10% LOTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000941", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EV CATH DIR CHEM ABLTJ W/IMG", "code_information": [{"code": "524T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EV FEMPOP ARTL REVSC", "code_information": [{"code": "505T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAC MEIBOMIAN GLND HEAT BI", "code_information": [{"code": "563T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAC RPR A-BIILIAC NDGFT", "code_information": [{"code": "34705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVACUATE MOLE OF UTERUS", "code_information": [{"code": "59870", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL AMNIOTIC FLUID PROTEIN", "code_information": [{"code": "84112", "type": "CPT"}], "standard_charges": [{"minimum": 102.04, "maximum": 112.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 112.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL APPROS SURG THXPY EPI", "code_information": [{"code": "5200F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ 1ST HOUR", "code_information": [{"code": "92626", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ EA ADDL 15", "code_information": [{"code": "92627", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL MOD/DEEP SED/GEN ANEST", "code_information": [{"code": "D9219", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL ON FOOT DOCUMENTED", "code_information": [{"code": "G8410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL ON FOOT NOT PERFORMED", "code_information": [{"code": "G8415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL RISK VTE CARD 30D PRIOR", "code_information": [{"code": "G9298", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL SELF-ASSESS DEPRESSION", "code_information": [{"code": "S3005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATE PT USE OF INHALER", "code_information": [{"code": "94664", "type": "CPT"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATE SPEECH PRODUCTION", "code_information": [{"code": "92522", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATE SWALLOWING FUNCTION", "code_information": [{"code": "92610", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "estimated_discounted_cash": 218.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION BY OCULARIST", "code_information": [{"code": "S9150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION CERVICAL MUCUS", "code_information": [{"code": "89330", "type": "CPT"}], "standard_charges": [{"minimum": 11.94, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION FOR WHEELCHAIR", "code_information": [{"code": "G9156", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION HEART DEVICE", "code_information": [{"code": "93640", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF SPEECH FLUENCY", "code_information": [{"code": "92521", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF WHEEZING", "code_information": [{"code": "94060", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF WHEEZING", "code_information": [{"code": "94070", "type": "CPT"}], "standard_charges": [{"minimum": 326.52, "maximum": 326.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 326.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT 1ST", "code_information": [{"code": "61650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT ADD", "code_information": [{"code": "61651", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT", "code_information": [{"code": "34701", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT RPT", "code_information": [{"code": "34702", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-BIILIAC RPT", "code_information": [{"code": "34706", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-ILIAC NDGFT", "code_information": [{"code": "34717", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT", "code_information": [{"code": "34703", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT RPT", "code_information": [{"code": "34704", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC NDGFT", "code_information": [{"code": "34707", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC RPT", "code_information": [{"code": "34708", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR N/A A-ILIAC NDGFT", "code_information": [{"code": "34718", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA ACRS BR", "code_information": [{"code": "33894", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA X CRSG", "code_information": [{"code": "33895", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC VEN ARTLZ TIBL/PRNL VN", "code_information": [{"code": "620T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVENT RECORDER, CARDIAC", "code_information": [{"code": "C1764", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVISTA (RALOXIFENE) 60MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000313", "type": "CDM"}, {"code": "65862070930", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST LIMITED", "code_information": [{"code": "92587", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST QUAL", "code_information": [{"code": "92558", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TST COMPLETE", "code_information": [{"code": "92588", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EWH S/D UPRT MICRO SENSOR", "code_information": [{"code": "L8701", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EWHF S/D UPRT MICRO SENSOR", "code_information": [{"code": "L8702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EX ARM/ELBOW TUM DEEP 5 CM/>", "code_information": [{"code": "24073", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EX ARM/ELBOW TUM DEEP < 5 CM", "code_information": [{"code": "24076", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEV RX ADD", "code_information": [{"code": "92618", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEVICE RX", "code_information": [{"code": "92605", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX 1HR", "code_information": [{"code": "92607", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX ADDL", "code_information": [{"code": "92608", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXAM FECES FOR MEAT FIBERS", "code_information": [{"code": "89160", "type": "CPT"}], "standard_charges": [{"minimum": 5.58, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXAM OF CERVIX W/SCOPE", "code_information": [{"code": "57452", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXAM OF VAGINA W/SCOPE", "code_information": [{"code": "57420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXAM OF VULVA W/SCOPE", "code_information": [{"code": "56820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VAG W/SCOPE", "code_information": [{"code": "57421", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VULVA W/SCOPE", "code_information": [{"code": "56821", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABD LES SC 3 CM/>", "code_information": [{"code": "22903", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABD LES SC < 3 CM", "code_information": [{"code": "22902", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP 5 CM/>", "code_information": [{"code": "22901", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP < 5 CM", "code_information": [{"code": "22900", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ARM/ELBOW LES SC 3 CM/>", "code_information": [{"code": "24071", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ARM/ELBOW LES SC < 3 CM", "code_information": [{"code": "24075", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC BACK LES SC 3 CM/>", "code_information": [{"code": "21931", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC BACK LES SC < 3 CM", "code_information": [{"code": "21930", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC BACK TUM DEEP 5 CM/>", "code_information": [{"code": "21933", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC BACK TUM DEEP < 5 CM", "code_information": [{"code": "21932", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC BIOPSY OF SALIV GLANDS", "code_information": [{"code": "D7284", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/LYMPHADEC", "code_information": [{"code": "21603", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/O LYMPHADEC", "code_information": [{"code": "21602", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC CHEST WALL TUMOR W/RIBS", "code_information": [{"code": "21601", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 0.5CM<", "code_information": [{"code": "11640", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 0.6-1", "code_information": [{"code": "11641", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 1.1-2", "code_information": [{"code": "11642", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 2.1-3", "code_information": [{"code": "11643", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 3.1-4", "code_information": [{"code": "11644", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG >4 CM", "code_information": [{"code": "11646", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE LES SBQ 2 CM/>", "code_information": [{"code": "21012", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE LES SC <2 CM", "code_information": [{"code": "21011", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP 2 CM/>", "code_information": [{"code": "21014", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP < 2 CM", "code_information": [{"code": "21013", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 0.5 CM/<", "code_information": [{"code": "11440", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 0.6-1 CM", "code_information": [{"code": "11441", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 1.1-2 CM", "code_information": [{"code": "11442", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 2.1-3 CM", "code_information": [{"code": "11443", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 3.1-4 CM", "code_information": [{"code": "11444", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG >4 CM", "code_information": [{"code": "11446", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEEP <1.5CM", "code_information": [{"code": "28045", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEP 1.5CM/>", "code_information": [{"code": "28041", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM SC 1.5 CM/>", "code_information": [{"code": "28039", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM SC < 1.5 CM", "code_information": [{"code": "28043", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM LES SC 3 CM/>", "code_information": [{"code": "25071", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM LES SC < 3 CM", "code_information": [{"code": "25075", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP 3 CM/>", "code_information": [{"code": "25073", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP < 3 CM", "code_information": [{"code": "25076", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 0.5/<", "code_information": [{"code": "11420", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 0.6-1", "code_information": [{"code": "11421", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 1.1-2", "code_information": [{"code": "11422", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 2.1-3", "code_information": [{"code": "11423", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 3.1-4", "code_information": [{"code": "11424", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG >4 CM", "code_information": [{"code": "11426", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP MAL+MARG 0.5/<", "code_information": [{"code": "11620", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC HAND LES SC 1.5 CM/>", "code_information": [{"code": "26111", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC HAND LES SC < 1.5 CM", "code_information": [{"code": "26115", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP 1.5 CM/>", "code_information": [{"code": "26113", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP < 1.5 CM", "code_information": [{"code": "26116", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC HIP PELVIS LES SC 3 CM/>", "code_information": [{"code": "27043", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP 5 CM/>", "code_information": [{"code": "27045", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP < 5 CM", "code_information": [{"code": "27048", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELVIS LES SC < 3 CM", "code_information": [{"code": "27047", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE LES SC 3 CM/>", "code_information": [{"code": "27632", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM < 3 CM", "code_information": [{"code": "27618", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEEP <5 CM", "code_information": [{"code": "27619", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEP 5 CM/>", "code_information": [{"code": "27634", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC NECK LES SC 3 CM/>", "code_information": [{"code": "21552", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC NECK LES SC < 3 CM", "code_information": [{"code": "21555", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC NECK TUM DEEP 5 CM/>", "code_information": [{"code": "21554", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC NECK TUM DEEP < 5 CM", "code_information": [{"code": "21556", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC NEUROMA W/ IMPLNT NV END", "code_information": [{"code": "C7551", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL FULL", "code_information": [{"code": "45172", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL PART", "code_information": [{"code": "45171", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC RECTAL TUMOR ENDOSCOPIC", "code_information": [{"code": "184T", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 0.6-1", "code_information": [{"code": "11621", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 1.1-2", "code_information": [{"code": "11622", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 2.1-3", "code_information": [{"code": "11623", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 3.1-4", "code_information": [{"code": "11624", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG >4 CM", "code_information": [{"code": "11626", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER LES SC 3 CM/>", "code_information": [{"code": "23071", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER LES SC < 3 CM", "code_information": [{"code": "23075", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP 5 CM/>", "code_information": [{"code": "23073", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [{"code": "23076", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD", "code_information": [{"code": "15830", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD ADD-ON", "code_information": [{"code": "15847", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U COMPLEX", "code_information": [{"code": "11471", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U SMPL/NTRM", "code_information": [{"code": "11470", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX COMPLEX", "code_information": [{"code": "11451", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX SMPL/NTRM", "code_information": [{"code": "11450", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING COMPLEX", "code_information": [{"code": "11463", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING SMPL/NTRM", "code_information": [{"code": "11462", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES SC 3 CM/>", "code_information": [{"code": "27337", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES SC < 3 CM", "code_information": [{"code": "27327", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEEP <5CM", "code_information": [{"code": "27328", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEP 5CM/>", "code_information": [{"code": "27339", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 1.1-2 CM", "code_information": [{"code": "11402", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 2.1-3CM", "code_information": [{"code": "11403", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 3.1-4 CM", "code_information": [{"code": "11404", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG >4.0 CM", "code_information": [{"code": "11406", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.5 CM/<", "code_information": [{"code": "11600", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.6-1 CM", "code_information": [{"code": "11601", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 1.1-2 CM", "code_information": [{"code": "11602", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 2.1-3 CM", "code_information": [{"code": "11603", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 3.1-4 CM", "code_information": [{"code": "11604", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG >4 CM", "code_information": [{"code": "11606", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/B9 TUM RDS", "code_information": [{"code": "24120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM AGRF", "code_information": [{"code": "24115", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM ALGR", "code_information": [{"code": "24116", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS AGRF", "code_information": [{"code": "24125", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS ALGR", "code_information": [{"code": "24126", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC/CURTG B1 CST/B9 TUM HUM", "code_information": [{"code": "24110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCAVATE TOOTH NON-RESTORABL", "code_information": [{"code": "D2989", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCELLAGEN, 0.1 CC", "code_information": [{"code": "Q4149", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCH BIL CATH W/ RMV CALCULI", "code_information": [{"code": "C7545", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCH NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7548", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCHANGE BILIARY DRG CATH", "code_information": [{"code": "47536", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCHANGE DRAINAGE CATHETER", "code_information": [{"code": "49423", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCHANGE LENS PROSTHESIS", "code_information": [{"code": "66986", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCHANGE NEPHROSTOMY CATH", "code_information": [{"code": "50435", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS 250-500", "code_information": [{"code": "96921", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS<250SQCM", "code_information": [{"code": "96920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS>500SQCM", "code_information": [{"code": "96922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCIS UPPR JAW CYST W/REPAIR", "code_information": [{"code": "21049", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE ANAL EXT TAG/PAPILLA", "code_information": [{"code": "46220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE BENIGN LESION .06 TO 1.0CM", "code_information": [{"code": "11401", "type": "CPT"}, {"code": "11000043", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 575.2, "maximum": 1422.05, "gross_charge": 1009.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 756.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 807.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 908.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 575.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE BREAST DUCT FISTULA", "code_information": [{"code": "19112", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EPIPHYSEAL BAR", "code_information": [{"code": "20150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN & TISSUE", "code_information": [{"code": "15839", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN ARM/HAND", "code_information": [{"code": "15837", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN FAT PAD", "code_information": [{"code": "15838", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN ARM", "code_information": [{"code": "15836", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN BUTTCK", "code_information": [{"code": "15835", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN HIP", "code_information": [{"code": "15834", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN LEG", "code_information": [{"code": "15833", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN THIGH", "code_information": [{"code": "15832", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28086", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28088", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE ILEOANAL RESERVIOR", "code_information": [{"code": "45136", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INFERIOR TURBINATE", "code_information": [{"code": "30130", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTESTINE LESION(S)", "code_information": [{"code": "44110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRASPINL LESION CRV", "code_information": [{"code": "63265", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION CRVL", "code_information": [{"code": "63270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION LMBR", "code_information": [{"code": "63267", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION LMBR", "code_information": [{"code": "63272", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63268", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63273", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63266", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63271", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE LESION TESTIS", "code_information": [{"code": "54512", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE LIP OR CHEEK FOLD", "code_information": [{"code": "40819", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE LWR JAW CYST W/REPAIR", "code_information": [{"code": "21047", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE MANDIBLE LESION", "code_information": [{"code": "21040", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA B9 TUMOR", "code_information": [{"code": "21030", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA MAL TUMOR", "code_information": [{"code": "21034", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE ORAL MUCOSA FOR GRAFT", "code_information": [{"code": "40818", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42410", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42415", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42420", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42425", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42426", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE PHARYNX LESION", "code_information": [{"code": "42808", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE SACRAL SPINE TUMOR", "code_information": [{"code": "49215", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBLINGUAL GLAND", "code_information": [{"code": "42450", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBMAXILLARY GLAND", "code_information": [{"code": "42440", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE TENDON FOREARM/WRIST", "code_information": [{"code": "25109", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE WRIST TENDON SHEATH", "code_information": [{"code": "25118", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40812", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40814", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION ADDL BREAST LESION", "code_information": [{"code": "19126", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION COMPL", "code_information": [{"code": "D7412", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION>1.25C", "code_information": [{"code": "D7411", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION BREAST LESION", "code_information": [{"code": "19125", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION CONSTRICTING TISSUE", "code_information": [{"code": "26596", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT ABDOMEN", "code_information": [{"code": "35907", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT EXTREMITY", "code_information": [{"code": "35903", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT NECK", "code_information": [{"code": "35901", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT THORAX", "code_information": [{"code": "35905", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION GUM EACH QUADRANT", "code_information": [{"code": "41820", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION HAND/FINGER TENDON", "code_information": [{"code": "26415", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION HYPERPLASTIC TISSUE", "code_information": [{"code": "D7970", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42104", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42106", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42107", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LES COMPLICAT", "code_information": [{"code": "D7415", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LESION<=1.25C", "code_information": [{"code": "D7413", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LESION>1.25CM", "code_information": [{"code": "D7414", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION NAIL & MATRIX", "code_information": [{"code": "11750", "type": "CPT"}, {"code": "11000045", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 575.2, "maximum": 1422.05, "gross_charge": 1009.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 756.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 807.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 908.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 575.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ANAL LESION(S)", "code_information": [{"code": "46922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BENIGN LESION TECH .5CM OR L", "code_information": [{"code": "11400", "type": "CPT"}, {"code": "11000048", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 979.57, "maximum": 1546.69, "gross_charge": 1718.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1288.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1374.84, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1546.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 979.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT CYST", "code_information": [{"code": "47715", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47711", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47712", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BONE LOWER JAW", "code_information": [{"code": "21025", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL LESION(S)", "code_information": [{"code": "44111", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL POUCH", "code_information": [{"code": "44800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BRAIN TUMOR", "code_information": [{"code": "61545", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF FACIAL BONE(S)", "code_information": [{"code": "21026", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM FLAP", "code_information": [{"code": "41821", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41822", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41823", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41825", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41826", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41827", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41828", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HIP JOINT/MUSCLE", "code_information": [{"code": "27036", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LINGUAL TONSIL", "code_information": [{"code": "42870", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MESENTERY LESION", "code_information": [{"code": "44820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40810", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40816", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "41116", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NAIL FOLD TOE", "code_information": [{"code": "11765", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NECK CYST", "code_information": [{"code": "42810", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NECK CYST", "code_information": [{"code": "42815", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PENIS LESION(S)", "code_information": [{"code": "54060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL LESION", "code_information": [{"code": "45160", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45130", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL STRICTURE", "code_information": [{"code": "45150", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SALIVARY CYST", "code_information": [{"code": "42408", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SALIVARY GLAND", "code_information": [{"code": "D7981", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61563", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61564", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61558", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61559", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43611", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE FOLD", "code_information": [{"code": "41115", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41110", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41112", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41113", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41114", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONSIL TAGS", "code_information": [{"code": "42860", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UMBILICUS", "code_information": [{"code": "49250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UVULA", "code_information": [{"code": "42140", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OLECRANON BURSA", "code_information": [{"code": "24105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION PERICORONAL GINGIVA", "code_information": [{"code": "D7971", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION RADIAL HEAD", "code_information": [{"code": "24130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPEN ANY METHOD", "code_information": [{"code": "33267", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPN OTH PX ANY METH", "code_information": [{"code": "33268", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCL LAA THRSCP ANY METHOD", "code_information": [{"code": "33269", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXELON (RIVAST TART) CAP 1.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000792", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EXELON (RIVAST TART) CAP 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200143", "type": "CDM"}, {"code": "65862064960", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EXELON (RIVAST TART) CAP 4.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000569", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EXELON PATCH 4.6MG/24HRS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000441", "type": "CDM"}, {"code": "00078050115", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EXELON TD PATCH 9.5MG/24HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004439", "type": "CDM"}, {"code": "00078050215", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EXEMESTANE, 25 MG", "code_information": [{"code": "S0156", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXERCISE CLASS", "code_information": [{"code": "S9451", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXERCISE EQUIPMENT", "code_information": [{"code": "A9300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM W/ECG", "code_information": [{"code": "94617", "type": "CPT"}], "standard_charges": [{"minimum": 326.52, "maximum": 326.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 326.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM WO ECG", "code_information": [{"code": "94619", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXERCISE W/HEMODYNAMIC MEAS", "code_information": [{"code": "93464", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXFOLIATIVE CYTOLOG COLLECT", "code_information": [{"code": "D7287", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXFORGE TAB 10MG/160MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000808", "type": "CDM"}, {"code": "00078048915", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS", "code_information": [{"code": "94690", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2", "code_information": [{"code": "94680", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2/CO2", "code_information": [{"code": "94681", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXHALED BREATH CONDENSATE", "code_information": [{"code": "83987", "type": "CPT"}], "standard_charges": [{"minimum": 4.12, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXHALED NITRIC OXIDE MEAS", "code_information": [{"code": "95012", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXOME RE-EVALUATION", "code_information": [{"code": "81417", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 368.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81415", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 5497.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5497.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81416", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 13800.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13800.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG LXTR ART", "code_information": [{"code": "35703", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG NECK ART", "code_information": [{"code": "35701", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG UXTR ART", "code_information": [{"code": "35702", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND ABDOMEN", "code_information": [{"code": "49010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND UPPER JAW", "code_information": [{"code": "31040", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54550", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54560", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31020", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31030", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31256", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "49000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "58960", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ANKLE JOINT", "code_information": [{"code": "27612", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF BILE DUCTS", "code_information": [{"code": "47700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "32100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FOOT JOINT", "code_information": [{"code": "28020", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FOOT JOINT", "code_information": [{"code": "28022", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31070", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31075", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF HIP JOINT", "code_information": [{"code": "27033", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KIDNEY", "code_information": [{"code": "50010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KNEE JOINT", "code_information": [{"code": "27310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF MIDDLE EAR", "code_information": [{"code": "69440", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SINUSES", "code_information": [{"code": "31090", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SPINAL FUSION", "code_information": [{"code": "22830", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF TOE JOINT", "code_information": [{"code": "28024", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF URETER", "code_information": [{"code": "50600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF VAGINA", "code_information": [{"code": "57000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION SPHENOID SINUS", "code_information": [{"code": "31050", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45562", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45563", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33315", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23044", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE ABDOMINAL VESSELS", "code_information": [{"code": "35840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60545", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST FREE ADHESIONS", "code_information": [{"code": "32124", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST VESSELS", "code_information": [{"code": "35820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE DEEP NODE(S) NECK", "code_information": [{"code": "38542", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE EPIDIDYMIS", "code_information": [{"code": "54865", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69805", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69806", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE LIMB VESSELS", "code_information": [{"code": "35860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE NECK VESSELS", "code_information": [{"code": "35800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE ORBIT/REMOVE LESION", "code_information": [{"code": "61333", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60500", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE SCROTUM", "code_information": [{"code": "55110", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE SINUS REMOVE POLYPS", "code_information": [{"code": "31032", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE SMALL INTESTINE", "code_information": [{"code": "44020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE TREAT SHOULDER JOINT", "code_information": [{"code": "23107", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND ABDOMEN", "code_information": [{"code": "20102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND CHEST", "code_information": [{"code": "20101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND EXTREMITY", "code_information": [{"code": "20103", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND NECK", "code_information": [{"code": "20100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67400", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67450", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67405", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67440", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/IRRIGATE TEAR DUCTS", "code_information": [{"code": "68840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/REPAIR CHEST", "code_information": [{"code": "32110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67412", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67413", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67420", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67430", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT FINGER JOINT", "code_information": [{"code": "26075", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT FINGER JOINT", "code_information": [{"code": "26080", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT HAND JOINT", "code_information": [{"code": "26070", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT KNEE JOINT", "code_information": [{"code": "27331", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67414", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67445", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPOSURE OF UNERUPTED TOOTH", "code_information": [{"code": "D7280", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXSUFF BELT INCL ALL SUP ACC", "code_information": [{"code": "A4468", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT AMB INSULIN DELIVERY SYS", "code_information": [{"code": "A9274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REC SCAN A/R", "code_information": [{"code": "93241", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D RECORDING", "code_information": [{"code": "93242", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REV&INTERPJ", "code_information": [{"code": "93244", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D SCAN A/R", "code_information": [{"code": "93243", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REC SCAN A/R", "code_information": [{"code": "93245", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D RECORDING", "code_information": [{"code": "93246", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REV&INTERPJ", "code_information": [{"code": "93248", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D SCAN A/R", "code_information": [{"code": "93247", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT LINE W EASY LOCK CONNECT", "code_information": [{"code": "A4673", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT RECHARGE BAT REPLACEMENT", "code_information": [{"code": "K1030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXT TRNSCRANL MAG STIMJ MEAS", "code_information": [{"code": "858T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENDED CULTURE OF OOCYTES", "code_information": [{"code": "89272", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 519.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 519.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENDED VISUAL FIELD XM", "code_information": [{"code": "92083", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [{"code": "927", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [{"code": "933", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR CANAL SURGERY", "code_information": [{"code": "69150", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR/NECK SURGERY", "code_information": [{"code": "69155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HAND SURGERY", "code_information": [{"code": "26250", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE JAW SURGERY", "code_information": [{"code": "21045", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69511", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69530", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "982", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "981", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "983", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55812", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55815", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55842", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55862", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55865", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE REMOVAL OF LIVER", "code_information": [{"code": "47122", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21630", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42842", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42844", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE TESTIS SURGERY", "code_information": [{"code": "54535", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE THYROID SURGERY", "code_information": [{"code": "60254", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56630", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56631", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56632", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56633", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56634", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56637", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56640", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSV ORAL EVAL PROB FOCUS", "code_information": [{"code": "D0160", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTERNAL BEAM TO PROST ONLY", "code_information": [{"code": "4200F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTERNAL BLEACHING HOME APP", "code_information": [{"code": "D9975", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTERNAL CANNULA DECLOTTING", "code_information": [{"code": "36860", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTERNAL OCULAR PHOTOGRAPHY", "code_information": [{"code": "92285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTERNAL PACEMAKER", "code_information": [{"code": "92953", "type": "CPT"}, {"code": "11000225", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 876.64, "maximum": 2061.93, "gross_charge": 1537.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1153.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1230.38, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2061.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1384.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 876.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL RECEIVER, CGM SYS", "code_information": [{"code": "A9278", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTERNAL TRANSMITTER, CGM", "code_information": [{"code": "A9277", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTND COLOR VISION XM", "code_information": [{"code": "92283", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRA AMBULANCE ATTENDANT", "code_information": [{"code": "A0424", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRA ORAL POST RADIO IMAGE", "code_information": [{"code": "D0705", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "38", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "37", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "39", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTRACTION CORONAL REMNANTS", "code_information": [{"code": "D7111", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRACTION ERUPTED TOOTH/EXR", "code_information": [{"code": "D7140", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66920", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66930", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66940", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [{"code": "115", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTRAORAL 2D PROJECT IMAGE", "code_information": [{"code": "D0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRAORAL POSTERIOR IMAGE", "code_information": [{"code": "D0251", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [{"code": "790", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTRNL BEAM OTHER THAN PROST", "code_information": [{"code": "4201F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRNL BLEACHING PER ARCH", "code_information": [{"code": "D9972", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRNL BLEACHING PER TOOTH", "code_information": [{"code": "D9973", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRNL COUNTERPULSE, PER TX", "code_information": [{"code": "G0166", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE ALLERGY TESTS", "code_information": [{"code": "95060", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE GLASS CASE", "code_information": [{"code": "V2756", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE IMG VALID EVC RTNOPTHY", "code_information": [{"code": "2026F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE IMG VALID W/O RTNOPTHY", "code_information": [{"code": "2033F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE MVMT ALYS W/O CALBRJ I&R", "code_information": [{"code": "615T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE PAD", "code_information": [{"code": "3000178", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EYE PHOTODYNAMIC THER ADD-ON", "code_information": [{"code": "67225", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE SHIELD FOX ALUMINUM", "code_information": [{"code": "3000179", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "EYE SURGERY FOLLOW-UP ADD-ON", "code_information": [{"code": "67331", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE SUTURE DURING SURGERY", "code_information": [{"code": "67335", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYEGLASSES DELUX FRAMES", "code_information": [{"code": "V2025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EZDERM", "code_information": [{"code": "Q4136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE COMMON VARIANTS", "code_information": [{"code": "81237", "type": "CPT"}], "standard_charges": [{"minimum": 201.71, "maximum": 201.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81236", "type": "CPT"}], "standard_charges": [{"minimum": 325.31, "maximum": 325.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 325.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (DHMT) device that augments a behavioral therapy plan, physician/other qualified health care profe", "code_information": [{"code": "G0554", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Elastomeric infusion pump (e.g., On-Q* pump with bolus), including catheter and all disposable system components, non-opioid medical device (must be a qualifying Medicare non-opioid Medical device for post-surgical pain relief in accordance with section 4", "code_information": [{"code": "C9804", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram, algorithmically generated 12-lead ECG from a reduced-lead ECG; interpretation and report only", "code_information": [{"code": "905T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram, algorithmically generated 12-lead ECG from a reduced-lead ECG; tracing only", "code_information": [{"code": "904T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram, algorithmically generated 12-lead ECG from a reduced-lead ECG; with interpretation and report", "code_information": [{"code": "903T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electrode for external lower extremity nerve stimulator for restless legs syndrome", "code_information": [{"code": "A4544", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electronic analysis of implanted integrated neurostimulation system, vagus nerve; with simple programming by physician or other qualified health care professional", "code_information": [{"code": "912T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electronic analysis of implanted integrated neurostimulation system, vagus nerve; without programming by physician or other qualified health care professional", "code_information": [{"code": "911T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of sensing and therapy for arrhythmia termination), at time of initial implantation o", "code_information": [{"code": "930T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of sensing and therapy for arrhythmia termination), separate from initial implantatio", "code_information": [{"code": "931T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Emboli detection without intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)", "code_information": [{"code": "93897", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Enclose TL matrix, per square centimeter", "code_information": [{"code": "Q4351", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "End-tidal control of inhaled anesthetic agents and oxygen to assist anesthesia care delivery (List separately in addition to code for primary procedure)", "code_information": [{"code": "887T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components", "code_information": [{"code": "C9901", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping", "code_information": [{"code": "L5827", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ensifentrine, inhalation suspension, FDA approved final product, non-compounded, administered through DME, unit dose form, 3 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EpiPen 0.3MG/0.3ML AUTO-INJECTOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0171", "type": "HCPCS"}, {"code": "72001102", "type": "CDM"}, {"code": "49502010202", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 435.75, "estimated_discounted_cash": 75.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Epixpress, per square centimeter", "code_information": [{"code": "Q4361", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ertapenem Inj Powder for Solution 1GM", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J1335", "type": "HCPCS"}, {"code": "7004513", "type": "CDM"}, {"code": "43598090158", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 30.76, "maximum": 48.57, "gross_charge": 53.97, "discounted_cash": 54.17, "estimated_discounted_cash": 111.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 43.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 48.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Esophagoscopy, flexible, transoral, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for esophageal stricture, including fluoroscopic guidance, when perform", "code_information": [{"code": "884T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 10.1 to 20 cm", "code_information": [{"code": "49188", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 20.1 to 30 cm", "code_information": [{"code": "49189", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 cm or less", "code_information": [{"code": "49186", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5.1 to 10 cm", "code_information": [{"code": "49187", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); greater than 30 cm", "code_information": [{"code": "49190", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; including recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professi", "code_information": [{"code": "937T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; recording (including connection and initial recording)", "code_information": [{"code": "938T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional", "code_information": [{"code": "940T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; scanning analysis with report", "code_information": [{"code": "939T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "External lower extremity nerve stimulator for restless legs syndrome, each", "code_information": [{"code": "E0743", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "External lower extremity sensory prosthesis, cutaneous stimulation of mechanoreceptors proximal to the ankle, per leg", "code_information": [{"code": "L8720", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "F EMB TRNS CANC CASE RATE", "code_information": [{"code": "S4018", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "F18 FDG", "code_information": [{"code": "A9552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "F18 FDG, 15 MILLICURIES", "code_information": [{"code": "A9609", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "F9 FULL GENE SEQUENCE", "code_information": [{"code": "81238", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 690.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAB REMOVABLE APPLIANCE", "code_information": [{"code": "D9938", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAB/DEL ORAL APPLIANCE THXPY", "code_information": [{"code": "D9954", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FABRIC WRAPPING OF ANEURYSM", "code_information": [{"code": "M0301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FABRICATION ATHLETIC GUARD", "code_information": [{"code": "D9941", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACE BONE GRAFT", "code_information": [{"code": "21210", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACIAL AUGMENTATION IMPLANT", "code_information": [{"code": "D5925", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACIAL MOULAGE COMPLETE", "code_information": [{"code": "D5912", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.19, "maximum": 185.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 185.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACIAL MOULAGE SECTIONAL", "code_information": [{"code": "D5911", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.19, "maximum": 185.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 185.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACIAL NERVE FUNCTION TEST", "code_information": [{"code": "92516", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACIAL PROSTHESIS", "code_information": [{"code": "D5919", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACIAL REPLACEMENT", "code_information": [{"code": "D5929", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACILITY SVS DENTAL REHAB", "code_information": [{"code": "G0330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR II ACTIVITY", "code_information": [{"code": "85210", "type": "CPT"}, {"code": "1000799", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.82, "maximum": 64.98, "gross_charge": 72.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 41.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR II DNA ANALYSIS", "code_information": [{"code": "81240", "type": "CPT"}, {"code": "1000841", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 75.54, "maximum": 202.2, "gross_charge": 224.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 75.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 179.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 202.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 128.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR INHIBITOR TEST", "code_information": [{"code": "85335", "type": "CPT"}], "standard_charges": [{"minimum": 14.8, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR IX ALPROLIX RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7201", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR IX COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7194", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR IX IDELVION INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7202", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR IX NON-RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7193", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMB GLY REBINYN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMBINAN RIXUBIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7200", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMBINANT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7195", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR V ACTIVITY", "code_information": [{"code": "85220", "type": "CPT"}, {"code": "1000800", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.3, "maximum": 88.31, "gross_charge": 98.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 78.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 88.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR V LEIDEN MUTATION", "code_information": [{"code": "81241", "type": "CPT"}, {"code": "1000514", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 84.38, "maximum": 291.49, "gross_charge": 323.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 84.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 259.1, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 291.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 184.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIIA RECOMB NOVOSEVEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7189", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIIA RECOMB SEVENFACT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7190", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII (PORCINE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7191", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII ACTIVITY", "code_information": [{"code": "85244", "type": "CPT"}, {"code": "1000801", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 23.48, "maximum": 102.19, "gross_charge": 113.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 90.84, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 102.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 64.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII FC FUSION RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7205", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII INHIBITOR PROFILE,COMPREHENS", "code_information": [{"code": "85240", "type": "CPT"}, {"code": "1000953", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.59, "maximum": 89.8, "gross_charge": 99.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.82, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII NUWIQ RECOMB 1IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7209", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII PEGYLATED RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7207", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII RECOMB NOVOEIGHT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7182", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII RECOMB OBIZUR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7188", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII RECOMBINANT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7192", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR X ANTIGEN", "code_information": [{"code": "85260", "type": "CPT"}, {"code": "1000684", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.59, "maximum": 95.39, "gross_charge": 105.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.79, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 95.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR X INHIBITOR", "code_information": [{"code": "85260", "type": "CPT"}, {"code": "1000685", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.59, "maximum": 95.39, "gross_charge": 105.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.79, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 95.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR XIII ANTI-HEM FACTOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7180", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR XIII RECOMB A-SUBUNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7181", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FALL PLAN OF CARE DOCD", "code_information": [{"code": "518F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FALL RISK ASSESSMENT DOCD", "code_information": [{"code": "3288F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAM ADAPT BHV TX GDN PHY/QHP", "code_information": [{"code": "97156", "type": "CPT"}], "standard_charges": [{"minimum": 15.07, "maximum": 15.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY ASSESSMENT", "code_information": [{"code": "H1011", "type": "HCPCS"}], "standard_charges": [{"minimum": 1848.13, "maximum": 1848.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1848.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY HOMECARE TRAIN/SESSIO", "code_information": [{"code": "S5111", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY HOMECARE TRAINING 15M", "code_information": [{"code": "S5110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY MEDICINE SS", "code_information": [{"code": "G4005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY PSYTX W/O PT 50 MIN", "code_information": [{"code": "90846", "type": "CPT"}], "standard_charges": [{"minimum": 481.58, "maximum": 481.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 481.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY PSYTX W/PT 50 MIN", "code_information": [{"code": "90847", "type": "CPT"}], "standard_charges": [{"minimum": 481.58, "maximum": 481.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 481.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY STABILIZATION 15 MIN", "code_information": [{"code": "S9482", "type": "HCPCS"}], "standard_charges": [{"minimum": 481.58, "maximum": 481.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 481.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY TRAINING & COUNSELING", "code_information": [{"code": "T1027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FAMILY/COUPLE COUNSELING", "code_information": [{"code": "T1006", "type": "HCPCS"}], "standard_charges": [{"minimum": 481.58, "maximum": 481.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 481.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FANCC GENE", "code_information": [{"code": "81242", "type": "CPT"}], "standard_charges": [{"minimum": 42.11, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FARXIGA 10MG ORAL TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001790", "type": "CDM"}, {"code": "00310621030", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FARXIGA ORAL TABLET 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004330", "type": "CDM"}, {"code": "66993045630", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FAST/DIR LDL >= 190 MG/DL", "code_information": [{"code": "G9663", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FCSD US ABLTJ LEIOMYOM>=200", "code_information": [{"code": "72T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FE PYRO CIT POW 0.1 MG IRON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1444", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FECAL BILIRUBIN TEST", "code_information": [{"code": "82252", "type": "CPT"}], "standard_charges": [{"minimum": 5.24, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FECAL BLOOD SCRN IMMUNOASSAY", "code_information": [{"code": "G0328", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FECAL CALPROTECTIN", "code_information": [{"code": "83993", "type": "CPT"}, {"code": "1000904", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 22.57, "maximum": 135.0, "gross_charge": 150.0, "discounted_cash": 54.17, "estimated_discounted_cash": 150.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL FAT QUALITATIVE", "code_information": [{"code": "82710", "type": "CPT"}, {"code": "1000240", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 19.32, "maximum": 89.5, "gross_charge": 99.45, "discounted_cash": 54.17, "estimated_discounted_cash": 99.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL FAT QUANTITATIVE 72 HR", "code_information": [{"code": "82705", "type": "CPT"}, {"code": "1000129", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.87, "maximum": 27.1, "gross_charge": 30.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL IMMUNOASSAY TESTING", "code_information": [{"code": "82274", "type": "CPT"}, {"code": "1000922", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.31, "maximum": 79.59, "gross_charge": 88.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 79.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 50.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA JSLM 1 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1440", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA PREP INSTIL", "code_information": [{"code": "G0455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FECAL REDUCING SUBSTANCE", "code_information": [{"code": "84377", "type": "CPT"}, {"code": "1000234", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.33, "maximum": 99.0, "gross_charge": 110.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEEDING AID", "code_information": [{"code": "D5951", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEEDING BAG 1000ML KANGAROO EPUMP", "code_information": [{"code": "3001236", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FEEDING BAG 1000ML SPIKE & FLUSH", "code_information": [{"code": "3001402", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.97, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FEEDING PUMP (DAILY", "code_information": [{"code": "B4035", "type": "HCPCS"}, {"code": "3000633", "type": "CDM"}, {"code": "291", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE I&R", "code_information": [{"code": "92617", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE TEST", "code_information": [{"code": "92616", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FELBATOL", "code_information": [{"code": "80339", "type": "CPT"}, {"code": "1000233", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "gross_charge": 58.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 52.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 33.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/ARTHR & US", "code_information": [{"code": "C7534", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/STENT & US", "code_information": [{"code": "C7535", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/ATHER", "code_information": [{"code": "37225", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/TLA", "code_information": [{"code": "37224", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC STNT & ATHER", "code_information": [{"code": "37227", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC W/STENT", "code_information": [{"code": "37226", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEMALE CONDOM", "code_information": [{"code": "A4268", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [{"code": "748", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FEMARA (LETROZOLE) 2.5MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000579", "type": "CDM"}, {"code": "51991075933", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FEMORAL ENDOVAS GRAFT ADD-ON", "code_information": [{"code": "34813", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FENTANYL CITRATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEOSOL (FERROUS SULFATE) TAB 325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000193", "type": "CDM"}, {"code": "00904759161", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FERGON (FERROUS GLUCONATE) TAB 324MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000192", "type": "CDM"}, {"code": "54629064501", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FERN TEST", "code_information": [{"code": "Q0114", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FERRITIN", "code_information": [{"code": "82728", "type": "CPT"}, {"code": "1000046", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.67, "maximum": 72.57, "gross_charge": 80.64, "discounted_cash": 54.17, "estimated_discounted_cash": 80.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERROUS FUMARATE 324MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003064", "type": "CDM"}, {"code": "60258018201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FERROUS SULFATE LIQUID 300MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002163", "type": "CDM"}, {"code": "00121053005", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FERUMOXYTOL, ESRD USE", "code_information": [{"code": "Q0139", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FERUMOXYTOL, NON-ESRD", "code_information": [{"code": "Q0138", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL ANEUPLOIDY TRISOM RISK", "code_information": [{"code": "81507", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 914.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 914.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFILE W/NST", "code_information": [{"code": "76818", "type": "CPT"}], "standard_charges": [{"minimum": 147.47, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 147.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML ANEUPLOIDY", "code_information": [{"code": "81420", "type": "CPT"}], "standard_charges": [{"minimum": 872.91, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 872.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML MICRODELTJ", "code_information": [{"code": "81422", "type": "CPT"}], "standard_charges": [{"minimum": 872.91, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 872.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL CONTRACT STRESS TEST", "code_information": [{"code": "59020", "type": "CPT"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL CORD PUNCTURE PRENATAL", "code_information": [{"code": "59012", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL FLUID DRAINAGE W/US", "code_information": [{"code": "59074", "type": "CPT"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR W/REPORT", "code_information": [{"code": "59050", "type": "CPT"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR/INTERPRET ONLY", "code_information": [{"code": "59051", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL NON-STRESS TEST", "code_information": [{"code": "59025", "type": "CPT"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SCALP BLOOD SAMPLE", "code_information": [{"code": "59030", "type": "CPT"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SHUNT PLACEMENT W/US", "code_information": [{"code": "59076", "type": "CPT"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SURG CONG CYST MALF", "code_information": [{"code": "S2402", "type": "HCPCS"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SURG CONGEN HERNIA", "code_information": [{"code": "S2400", "type": "HCPCS"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SURG MYELOMENINGO", "code_information": [{"code": "S2404", "type": "HCPCS"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SURG NOC", "code_information": [{"code": "S2409", "type": "HCPCS"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SURG PULMON SEQUEST", "code_information": [{"code": "S2403", "type": "HCPCS"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SURG SACROCOC TERATOMA", "code_information": [{"code": "S2405", "type": "HCPCS"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETAL SURG URIN TRAC OBSTR", "code_information": [{"code": "S2401", "type": "HCPCS"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETOSCOP LASER THER TTTS", "code_information": [{"code": "S2411", "type": "HCPCS"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FETROJA (CEFIDEROCOL SULF) 1GM INJ", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J0699", "type": "HCPCS"}, {"code": "72004332", "type": "CDM"}, {"code": "59630026610", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 404.12, "maximum": 638.09, "gross_charge": 708.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 531.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 567.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 638.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 404.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEV <40% PREDICTED VALUE", "code_information": [{"code": "3040F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEV >=40% PREDICTED VALUE", "code_information": [{"code": "3042F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [{"code": "864", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FIASP FOR INSULIN PUMP USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1811", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBERCON (NF-Fibercon) 625MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002449", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADATION PRODUCTS", "code_information": [{"code": "85362", "type": "CPT"}], "standard_charges": [{"minimum": 7.92, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADE SEMIQUANT", "code_information": [{"code": "85378", "type": "CPT"}], "standard_charges": [{"minimum": 11.18, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADJ D-DIMER", "code_information": [{"code": "85380", "type": "CPT"}], "standard_charges": [{"minimum": 11.71, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN ACTIVITY", "code_information": [{"code": "85384", "type": "CPT"}], "standard_charges": [{"minimum": 11.18, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN ANTIGEN", "code_information": [{"code": "85385", "type": "CPT"}, {"code": "1000798", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.82, "maximum": 42.52, "gross_charge": 47.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 42.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 26.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85366", "type": "CPT"}], "standard_charges": [{"minimum": 11.82, "maximum": 92.53, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 92.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85370", "type": "CPT"}], "standard_charges": [{"minimum": 14.29, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYSINS SCREEN I&R", "code_information": [{"code": "85390", "type": "CPT"}], "standard_charges": [{"minimum": 11.82, "maximum": 17.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC ANTIPLASMIN", "code_information": [{"code": "85410", "type": "CPT"}], "standard_charges": [{"minimum": 8.87, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMIN", "code_information": [{"code": "85400", "type": "CPT"}], "standard_charges": [{"minimum": 8.87, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85415", "type": "CPT"}], "standard_charges": [{"minimum": 19.77, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85420", "type": "CPT"}], "standard_charges": [{"minimum": 7.51, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85421", "type": "CPT"}], "standard_charges": [{"minimum": 11.71, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIBULA BONE GRAFT MICROVASC", "code_information": [{"code": "20955", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FILLETED FINGER/TOE FLAP", "code_information": [{"code": "14350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FILM BARRIER SKIN NO STING 1ML", "code_information": [{"code": "3000180", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FILTER BACT F/RESP THRPY-NONCONDUCTIVE", "code_information": [{"code": "3001301", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FILTER KIDNEY STONE", "code_information": [{"code": "3000181", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FILTER REM 3 MON PLMT", "code_information": [{"code": "G9541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FILTERED SPEECH HEARING TEST", "code_information": [{"code": "92571", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FILTERS FOR LEUKOPOO", "code_information": [{"code": "3000182", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FIMBRIOPLASTY", "code_information": [{"code": "58760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FINAL REF +/- 1.0 W/IN 90D", "code_information": [{"code": "G9519", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FINANCIAL MGT WAIVER/15MIN", "code_information": [{"code": "T2040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FINANCIAL MGT WAIVER/DIEM", "code_information": [{"code": "T2050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FINASTERIDE, 5 MG", "code_information": [{"code": "S0138", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FINGER PALM CONES", "code_information": [{"code": "3000184", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26497", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26498", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIRST-LANSOPRAZOLE PWD FOR SUSP 3MG/1ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003194", "type": "CDM"}, {"code": "65628008005", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 175.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FISH - BLADDER CA", "code_information": [{"code": "88271", "type": "CPT"}, {"code": "1000731", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 24.63, "maximum": 138.28, "gross_charge": 119.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 95.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 107.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 67.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISH OIL (OMEGA-3 KRILL OIL) 350MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001705", "type": "CDM"}, {"code": "20525095330", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FISH OIL CAP 1000 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000274", "type": "CDM"}, {"code": "11845014638", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FISTULA CANNULATION SET, EA", "code_information": [{"code": "A4730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FISTULA REPAIR & COLOSTOMY", "code_information": [{"code": "57307", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FISTULA REPAIR TRANSPERINE", "code_information": [{"code": "57308", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MONOFOCL", "code_information": [{"code": "92352", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MULTIFOC", "code_information": [{"code": "92353", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES BIFOCAL", "code_information": [{"code": "92341", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MONOFOCAL", "code_information": [{"code": "92340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MULTIFOCAL", "code_information": [{"code": "92342", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FITG C-LENS KERATOCONUS 1ST", "code_information": [{"code": "92072", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LOW VIS 1SYSTEM", "code_information": [{"code": "92354", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LW VIS CMPND LENS", "code_information": [{"code": "92355", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FITTING OF DIAPHRAGM/CAP", "code_information": [{"code": "57170", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIX G/COLON TUBE W/DEVICE", "code_information": [{"code": "49460", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIX PARTIAL DENTURE SECTION", "code_information": [{"code": "D9120", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXATION OF ANKLE JOINT", "code_information": [{"code": "27860", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXATION OF KNEE JOINT", "code_information": [{"code": "27570", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXATION OF SHOULDER BLADE", "code_information": [{"code": "23400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED APPLIANCE THERAPY HABT", "code_information": [{"code": "D8220", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED BILAT SPACE MAINT, MAN", "code_information": [{"code": "D1517", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED BILAT SPACE MAINT, MAX", "code_information": [{"code": "D1516", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED PARTIAL REPAIR", "code_information": [{"code": "D6980", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED PROSTHODONTIC PROC", "code_information": [{"code": "D6999", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED WING AIR MILEAGE", "code_information": [{"code": "A0435", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIXED WING AIR TRANSPORT", "code_information": [{"code": "A0430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLAG UNIFLAG PLEASE SIGN HERE RED", "code_information": [{"code": "80000520", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 919.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLAGYL (METRONIDAZOLE) 500MG/100ML INJ", "drug_information": {"unit": 50.0, "type": "EA"}, "code_information": [{"code": "J1836", "type": "HCPCS"}, {"code": "7000316", "type": "CDM"}, {"code": "00338105548", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLAGYL (METRONIDAZOLE) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000317", "type": "CDM"}, {"code": "60687052601", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLEBOGAMMA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1572", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLEET PREP KIT 3 (BISACODYL)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000506", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLEETS ENEMA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000235", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLEETS ENEMA REG", "code_information": [{"code": "3000189", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLEXERIL (CYCLOBENZAPRINE HCL) 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002678", "type": "CDM"}, {"code": "00904740004", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLEXERIL (CYCLOBENZAPRINE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000134", "type": "CDM"}, {"code": "00904740161", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLEXHD/ALLOPATCHHD/SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBOW", "code_information": [{"code": "24330", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBW W/ADVMNT", "code_information": [{"code": "24331", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOMAX (TAMSULOSIN) CAP 0.4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000194", "type": "CDM"}, {"code": "00904738361", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOMAX (TAMSULOSIN) SUSP. 0.4MG/2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001075", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLONASE (FLUTICASONE) NASAL SPRAY 50MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000195", "type": "CDM"}, {"code": "00054327099", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLORBETABEN F18 DIAGNOSTIC", "code_information": [{"code": "Q9983", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLORBETAPIR F18", "code_information": [{"code": "A9586", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLORINEF (FLUDROCORTISONE) TAB 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000419", "type": "CDM"}, {"code": "00904731706", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLORTAUCIPIR INJ 1 MILLICURI", "code_information": [{"code": "A9601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOTUFOLASTAT F18 DIAG 1 MCI", "code_information": [{"code": "A9608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOVENT (FLUTICASONE) 110MCG INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000196", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 181.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOVENT (FLUTICASONE) 220 MCG INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200066", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 551.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOVENT (FLUTICASONE) 44 MCG INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200065", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 265.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOW-SAFE II EZ NEB LARGE ADULT", "code_information": [{"code": "3001357", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOW-SAFE II EZ NEB SMALL ADULT", "code_information": [{"code": "3001356", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/ TC 1 MARKER", "code_information": [{"code": "88184", "type": "CPT"}], "standard_charges": [{"minimum": 70.71, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 70.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 16 & >", "code_information": [{"code": "88189", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 93.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 93.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 2-8", "code_information": [{"code": "88187", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 40.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 9-15", "code_information": [{"code": "88188", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 69.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 69.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/TC ADD-ON", "code_information": [{"code": "88185", "type": "CPT"}], "standard_charges": [{"minimum": 22.62, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOWERAMNIOFLO, 0.1 CC", "code_information": [{"code": "Q4177", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOWERAMNIOPATCH, PER SQ CM", "code_information": [{"code": "Q4178", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOWERDERM, PER SQ CM", "code_information": [{"code": "Q4179", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOWTRON GARMENT FOOT", "code_information": [{"code": "3001382", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 289.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOWTRON GARMENT KNEE HI", "code_information": [{"code": "3001378", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 150.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOWTRON GARMENT THIGH", "code_information": [{"code": "3001383", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 201.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOXIN OTIC SOLUTION 0.3%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001085", "type": "CDM"}, {"code": "60505036302", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLOXURIDINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9200", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE", "code_information": [{"code": "81245", "type": "CPT"}], "standard_charges": [{"minimum": 190.34, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 190.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ANALYSIS", "code_information": [{"code": "81246", "type": "CPT"}], "standard_charges": [{"minimum": 95.45, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ITD VARIANTS QUAN", "code_information": [{"code": "46U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU IMM NO ADMIN DOC REA", "code_information": [{"code": "M1300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU IMMUNIZE NO ADMIN", "code_information": [{"code": "M1308", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU IMMUNIZE ORDER/ADMIN", "code_information": [{"code": "M1299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU IMMUNO ADMIND RCVD", "code_information": [{"code": "4274F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU VAC PANDEM PRSRV FREE IM", "code_information": [{"code": "90666", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU VACCINE INJ 0.5 ML", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "90658", "type": "CPT"}, {"code": "72000295", "type": "CDM"}, {"code": "49281064315", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 29.92, "maximum": 86.4, "gross_charge": 52.5, "discounted_cash": 54.17, "estimated_discounted_cash": 52.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VACCINNE (FLUBLOK) INJ 0.5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "90673", "type": "CPT"}, {"code": "72001088", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 81.6, "maximum": 128.85, "gross_charge": 143.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 107.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 114.53, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 128.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUCICLOVINE F-18", "code_information": [{"code": "A9588", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUDARABINE PHOSPHATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9185", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUID CIRC COLD PAD W PUMP", "code_information": [{"code": "E0218", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUID FLOW OR FLUID GF 1 CC", "code_information": [{"code": "Q4206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUID PRESSURE MUSCLE", "code_information": [{"code": "20950", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLULAVAL VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2036", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUNISOLIDE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7641", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUO BILE DUCT IMAGING W/ICG", "code_information": [{"code": "C9776", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOCINOLONE OINTMENT 0.025% 15GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000521", "type": "CDM"}, {"code": "00713022415", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGIOSCOPY I&R", "code_information": [{"code": "92230", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGRPH MLTIFRAME", "code_information": [{"code": "92235", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN&ICG ANGIOGRAPHY", "code_information": [{"code": "92242", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORESCENCE LYMPH MAP W/ICG", "code_information": [{"code": "C9756", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT ANA", "code_information": [{"code": "86038", "type": "CPT"}, {"code": "1000777", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.9, "maximum": 64.39, "gross_charge": 71.55, "discounted_cash": 54.17, "estimated_discounted_cash": 72.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.24, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORIDE APPLICATOR", "code_information": [{"code": "D5986", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORINE-18 FLUORODEOXYGLUCO", "code_information": [{"code": "S8085", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORO EXAM OF G/COLON TUBE", "code_information": [{"code": "49465", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORO POLARIZE FETAL LUNG", "code_information": [{"code": "83663", "type": "CPT"}], "standard_charges": [{"minimum": 21.75, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUORODOPA F-18 DIAG PER MCI", "code_information": [{"code": "A9602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOROESTRADIOL F 18", "code_information": [{"code": "A9591", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOROGUIDE FOR SPINE INJECT", "code_information": [{"code": "77003", "type": "CPT"}], "standard_charges": [{"minimum": 134.31, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 134.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOROGUIDE FOR VEIN DEVICE", "code_information": [{"code": "77001", "type": "CPT"}], "standard_charges": [{"minimum": 129.84, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 129.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOROMETHOLONE 0.1% OPHTHALMIC SUSPE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001569", "type": "CDM"}, {"code": "60758088010", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLUOROSCOPY <1 HR PHYS/QHP", "code_information": [{"code": "76000", "type": "CPT"}], "standard_charges": [{"minimum": 54.75, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOROURACIL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOXETINE LEVEL", "code_information": [{"code": "80332", "type": "CPT"}, {"code": "1000611", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "gross_charge": 106.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUPHENAZINE DECANOATE 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUPHENAZINE LEVEL", "code_information": [{"code": "80342", "type": "CPT"}, {"code": "1000730", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "gross_charge": 68.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUTAMIDE 125 MG", "code_information": [{"code": "S0175", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUTEMETAMOL F18 DIAGNOSTIC", "code_information": [{"code": "Q9982", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUTTER DEVICE", "code_information": [{"code": "S8185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUVIRIN VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2037", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUZONE VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2038", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "estimated_discounted_cash": 52.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLYING INSECT SPRAY KILLER", "code_information": [{"code": "80000706", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 1368.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FMR1 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81243", "type": "CPT"}], "standard_charges": [{"minimum": 65.6, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81244", "type": "CPT"}], "standard_charges": [{"minimum": 51.62, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY PHYS/PSYCH", "code_information": [{"code": "70555", "type": "CPT"}], "standard_charges": [{"minimum": 984.01, "maximum": 984.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 984.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY TECH", "code_information": [{"code": "70554", "type": "CPT"}], "standard_charges": [{"minimum": 571.34, "maximum": 571.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 571.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN 1ST LES", "code_information": [{"code": "10009", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN EA ADDL", "code_information": [{"code": "10010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN 1ST LES", "code_information": [{"code": "10007", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN EA ADDL", "code_information": [{"code": "10008", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN 1ST LES", "code_information": [{"code": "10011", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN EA ADDL", "code_information": [{"code": "10012", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN 1ST LES", "code_information": [{"code": "10021", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN EA ADDL", "code_information": [{"code": "10004", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN 1ST LES", "code_information": [{"code": "10005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN EA ADDL", "code_information": [{"code": "10006", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FNDNGS MAMMO 2PT W/IN 3 DAYS", "code_information": [{"code": "5060F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOA DOC, CARE PLAN NOT DOC", "code_information": [{"code": "G9227", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOA NOT DOC AS BEING PERF", "code_information": [{"code": "G8540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOAM DRESSING WOUND FILLER", "code_information": [{"code": "A6215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOAM DRG >16<=48 SQ IN W/BDR", "code_information": [{"code": "A6213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOAM STABILITY FETAL LUNG", "code_information": [{"code": "83662", "type": "CPT"}], "standard_charges": [{"minimum": 21.75, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOCUS ON WOMEN'S HEALTH MVP", "code_information": [{"code": "M1366", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLATE RBC", "code_information": [{"code": "85014", "type": "CPT"}, {"code": "1000350", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.73, "maximum": 17.93, "gross_charge": 14.01, "discounted_cash": 54.17, "estimated_discounted_cash": 14.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLBIC 2MG-2.5MG-25MG TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001373", "type": "CDM"}, {"code": "51991038490", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FOLIC ACID", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "1099020", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.91, "maximum": 78.32, "gross_charge": 87.03, "discounted_cash": 54.17, "estimated_discounted_cash": 87.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000200", "type": "CDM"}, {"code": "00904722461", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FOLLICAL STIMULA HORMONE", "code_information": [{"code": "83001", "type": "CPT"}, {"code": "1000676", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.37, "maximum": 103.37, "gross_charge": 110.0, "discounted_cash": 54.17, "estimated_discounted_cash": 110.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLOW UP CARE PLAN MDD DOCD", "code_information": [{"code": "545F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLLOW UP HOME VISIT/PRENTAL", "code_information": [{"code": "H1004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLLOW UP PULM NOD", "code_information": [{"code": "G9345", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP ANGIOGRAPHY", "code_information": [{"code": "75898", "type": "CPT"}], "standard_charges": [{"minimum": 3545.46, "maximum": 3545.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3545.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP SURGERY OF EYE", "code_information": [{"code": "66250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP/REASSESSMENT", "code_information": [{"code": "S0316", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLLOWUP EVAL OF FOOT PT LOP", "code_information": [{"code": "G0246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOMEPIZOLE, 15 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1451", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FONDAPARINUX SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1652", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOOD THICKENER ORAL", "code_information": [{"code": "B4100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOOT EXAM PERFORMED", "code_information": [{"code": "2028F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOOT PRESS OFF LOAD SUPP DEV", "code_information": [{"code": "A9283", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH CC", "code_information": [{"code": "504", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH MCC", "code_information": [{"code": "503", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "505", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FOOT PROTECTOR & WARMER", "code_information": [{"code": "3000191", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FOOT PROTECTOR TODDLER", "code_information": [{"code": "3000192", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FOOT, ADDUCTUS POSITION, ADJ", "code_information": [{"code": "L3161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FORCEPS ESOPH BIOPSY DONE", "code_information": [{"code": "3150F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOREHEAD FLAP W/VASC PEDICLE", "code_information": [{"code": "15731", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FORENSIC AUTOPSY (NECROPSY)", "code_information": [{"code": "88040", "type": "CPT"}], "standard_charges": [{"minimum": 600.78, "maximum": 600.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 600.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FORENSIC CYTOPATHOLOGY", "code_information": [{"code": "88125", "type": "CPT"}], "standard_charges": [{"minimum": 29.1, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FORM MAR NURSING HOME", "code_information": [{"code": "80000484", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FORM YEARLY WEIGHT RECORD", "code_information": [{"code": "80000685", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1313.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FORMOTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FORMOTEROL FUMARATE, INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FORTAZ (CEFTAZIDIME) 1GM INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0713", "type": "HCPCS"}, {"code": "7000201", "type": "CDM"}, {"code": "44567023525", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORTAZ 1GM/50ML 0.9% NS IVPB", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0713", "type": "HCPCS"}, {"code": "72000795", "type": "CDM"}, {"code": "00173043400", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORTAZ 2GM/100ML 0.9% NS IVPB", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J0713", "type": "HCPCS"}, {"code": "72000959", "type": "CDM"}, {"code": "44567023610", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.46, "maximum": 14.94, "gross_charge": 16.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOS C CHLD NON-THER PER DIEM", "code_information": [{"code": "H0041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOS C CHLD NON-THER PER MON", "code_information": [{"code": "H0042", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOSAMAX (ALENDRONATE SODIUM) TAB 35MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000202", "type": "CDM"}, {"code": "69097022316", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FOSAMAX (ALENDRONATE SODIUM) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000617", "type": "CDM"}, {"code": "00093514056", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FOSAMAX (ALENDRONATE SODIUM) TAB 70MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200158", "type": "CDM"}, {"code": "69097022416", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 52.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FOSAPREPITANT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1453", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOSCARNET SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1455", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FQHC VISIT NEW PATIENT", "code_information": [{"code": "G0466", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FQHC VISIT, ESTAB PT", "code_information": [{"code": "G0467", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FQHC VISIT, IPPE OR AWV", "code_information": [{"code": "G0468", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FQHC VISIT, MH ESTAB PT", "code_information": [{"code": "G0470", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FQHC VISIT, MH NEW PT", "code_information": [{"code": "G0469", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FR FRZ PLASMA DONOR RETESTED", "code_information": [{"code": "P9060", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRACTIONATED ESTROGEN", "code_information": [{"code": "82672", "type": "CPT"}, {"code": "1000964", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 24.96, "maximum": 115.53, "gross_charge": 128.37, "discounted_cash": 54.17, "estimated_discounted_cash": 128.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 102.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 115.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 73.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTIONATION KETOSTEROIDS", "code_information": [{"code": "83593", "type": "CPT"}], "standard_charges": [{"minimum": 32.78, "maximum": 40.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRACTURE ASSESSMENT VIA DXA", "code_information": [{"code": "77086", "type": "CPT"}], "standard_charges": [{"minimum": 41.16, "maximum": 253.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 253.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [{"code": "562", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [{"code": "563", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITH MCC", "code_information": [{"code": "533", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [{"code": "534", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [{"code": "535", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [{"code": "536", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FRAGMENTING OF KIDNEY STONE", "code_information": [{"code": "50590", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRAME DUST MOP 5 WIDE", "code_information": [{"code": "80000827", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FRANCISELLA TULARENSIS", "code_information": [{"code": "86668", "type": "CPT"}], "standard_charges": [{"minimum": 16.28, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE FASCIAL FLAP MICROVASC", "code_information": [{"code": "15758", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE JEJUNUM FLAP MICROVASC", "code_information": [{"code": "43496", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE LIGHTCHAIN QUANT SERUM", "code_information": [{"code": "83883", "type": "CPT"}, {"code": "1000788", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.64, "maximum": 169.88, "gross_charge": 188.76, "discounted_cash": 54.17, "estimated_discounted_cash": 188.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 169.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 107.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE MYO/SKIN FLAP MICROVASC", "code_information": [{"code": "15756", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE OMENTAL FLAP MICROVASC", "code_information": [{"code": "49906", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE PHENYTOIN", "code_information": [{"code": "80186", "type": "CPT"}, {"code": "1000943", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.82, "maximum": 69.03, "gross_charge": 76.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.36, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 69.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE SKIN FLAP MICROVASC", "code_information": [{"code": "15757", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE/REMOVE CHEST LINING", "code_information": [{"code": "32320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREEING OF BOWEL ADHESION", "code_information": [{"code": "44005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRENULOPLASTY", "code_information": [{"code": "D7963", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRENULOTOMY OF PENIS", "code_information": [{"code": "54164", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRONTIER EXTENDED STAY DEMO", "code_information": [{"code": "G9140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD FREEZE/THAW", "code_information": [{"code": "86932", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 102.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 102.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD PREP", "code_information": [{"code": "86930", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 120.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 120.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD THAW", "code_information": [{"code": "86931", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 90.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FROZEN CELL PREPARATION", "code_information": [{"code": "88241", "type": "CPT"}], "standard_charges": [{"minimum": 13.9, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FROZEN IVF CASE RATE", "code_information": [{"code": "S4016", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FROZEN PLASMA, POOLED, SD", "code_information": [{"code": "P9023", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FS NO ODI 9-15MO", "code_information": [{"code": "M1043", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FS NO OKS", "code_information": [{"code": "M1141", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FS ODI 6-20WK POSTOP <= 22", "code_information": [{"code": "G2144", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FS ODI 9-15MO > 22", "code_information": [{"code": "G2143", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FS ODI 9-15MO POSTOP<= 22", "code_information": [{"code": "G2142", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FS OKS 9-15MO < 37 < 71", "code_information": [{"code": "M1046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FS OKS 9-15MO >= 37 >= 71", "code_information": [{"code": "M1045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FS WTH SCR NO ODI PRE AND P", "code_information": [{"code": "M1049", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FSODI 6-20WK >22 OR CHG 30PT", "code_information": [{"code": "G2145", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTH GR F/C/C/M/N/AX/G/H/F EA", "code_information": [{"code": "15241", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTH GR FR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "15240", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L 20 SQCM/<", "code_information": [{"code": "15260", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L EACH ADDL", "code_information": [{"code": "15261", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L 20 SQ CM/<", "code_information": [{"code": "15220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L EACH ADDL", "code_information": [{"code": "15221", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK 20 SQ CM/<", "code_information": [{"code": "15200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK EACH ADDL", "code_information": [{"code": "15201", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTL ANEUP DNA SEQ CMPR ALYS", "code_information": [{"code": "341U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY STR ALYS DNA", "code_information": [{"code": "252U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY TRSMY DNA SEQ", "code_information": [{"code": "327U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR 3 PROTEINS", "code_information": [{"code": "81509", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 1710.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1710.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FIVE ANAL", "code_information": [{"code": "81512", "type": "CPT"}], "standard_charges": [{"minimum": 79.95, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 79.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FOUR ANAL", "code_information": [{"code": "81511", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 176.53, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 176.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR THREE ANAL", "code_information": [{"code": "81510", "type": "CPT"}], "standard_charges": [{"minimum": 63.87, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 63.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR TWO PROTEINS", "code_information": [{"code": "81508", "type": "CPT"}], "standard_charges": [{"minimum": 62.45, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 62.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FULL FIELD ERG W/I&R", "code_information": [{"code": "92273", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FULL LENGTH SURG STOCKING", "code_information": [{"code": "A4510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH DEBRIDEMENT", "code_information": [{"code": "D4355", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH X-RAY OF TEETH", "code_information": [{"code": "70320", "type": "CPT"}], "standard_charges": [{"minimum": 68.8, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 68.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [{"code": "793", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC", "code_information": [{"code": "928", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC", "code_information": [{"code": "929", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [{"code": "934", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FUNCT STATUS PAST 12 MONTHS", "code_information": [{"code": "G9916", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUNCTION STAT ASSESSED RVWD", "code_information": [{"code": "1175F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUNCTIONAL BRAIN MAPPING", "code_information": [{"code": "96020", "type": "CPT"}], "standard_charges": [{"minimum": 1848.13, "maximum": 1848.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1848.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUNCTIONAL ELECTRIC STIM NOS", "code_information": [{"code": "E0770", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUNDUS PHOTOGRAPHY W/I&R", "code_information": [{"code": "92250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUNGI IDENTIFICATION MOLD", "code_information": [{"code": "87107", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUNGI IDENTIFICATION YEAST", "code_information": [{"code": "87106", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUNGUS NES ANTIBODY", "code_information": [{"code": "86671", "type": "CPT"}], "standard_charges": [{"minimum": 14.09, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUNGUS STAIN", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "1000368", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 6.2, "maximum": 28.62, "gross_charge": 31.8, "discounted_cash": 54.17, "estimated_discounted_cash": 31.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 25.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 18.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47780", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47785", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43341", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & STOMACH", "code_information": [{"code": "43320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47741", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE HAND BONES WITH GRAFT", "code_information": [{"code": "25825", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCTS & BOWEL", "code_information": [{"code": "47765", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS AND BOWEL", "code_information": [{"code": "48548", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE UPPER GI STRUCTURES", "code_information": [{"code": "47721", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE/GRAFT ADDED JOINT", "code_information": [{"code": "26863", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION 2 OR MORE 3D IMAGES", "code_information": [{"code": "D0395", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF ANKLE JOINT OPEN", "code_information": [{"code": "27870", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28750", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28755", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28760", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF ELBOW JOINT", "code_information": [{"code": "24800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64866", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64868", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JNT ADD-ON", "code_information": [{"code": "26861", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINT", "code_information": [{"code": "26860", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINTS", "code_information": [{"code": "C7506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26471", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26474", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28705", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28715", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28725", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28730", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28735", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28740", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND BONES", "code_information": [{"code": "25820", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND JOINT", "code_information": [{"code": "26843", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNEE", "code_information": [{"code": "27580", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE", "code_information": [{"code": "26850", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINT", "code_information": [{"code": "26516", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26517", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26518", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE WITH GRAFT", "code_information": [{"code": "26852", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF SKULL ARTERIES", "code_information": [{"code": "61711", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54900", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54901", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43825", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25301", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF THUMB", "code_information": [{"code": "26841", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF TIBIOFIBULAR JOINT", "code_information": [{"code": "27871", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF TOES", "code_information": [{"code": "28280", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & BOWEL", "code_information": [{"code": "50810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50750", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETERS", "code_information": [{"code": "50760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF WRIST JOINT", "code_information": [{"code": "25800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION RADIOULNAR JNT/ULNA", "code_information": [{"code": "25830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF ELBOW JOINT", "code_information": [{"code": "24802", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF FINGER JOINT", "code_information": [{"code": "26862", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF HAND JOINT", "code_information": [{"code": "26844", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25805", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUT1 GNOTYP FUT1 EXON 4", "code_information": [{"code": "185U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUT2 GNOTYP FUT2 EXON 2", "code_information": [{"code": "186U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR 1ST 100 SQ CM", "code_information": [{"code": "479T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR EA ADDL 100SQCM", "code_information": [{"code": "480T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXN GENE ANALYSIS", "code_information": [{"code": "233U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXN GENE CHARAC ALLELES", "code_information": [{"code": "81285", "type": "CPT"}], "standard_charges": [{"minimum": 316.05, "maximum": 316.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXN GENE DETC ABNOR ALLELES", "code_information": [{"code": "81284", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXN GENE FULL GENE SEQUENCE", "code_information": [{"code": "81286", "type": "CPT"}], "standard_charges": [{"minimum": 316.05, "maximum": 316.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXN GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81289", "type": "CPT"}], "standard_charges": [{"minimum": 212.98, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FXNL STATUS ASSESSED", "code_information": [{"code": "1170F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FY GNOTYP ACKR1 EXONS 1-2", "code_information": [{"code": "187U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Facility-based respite, 24-hour unit, for use in CMMI model", "code_information": [{"code": "G0531", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ferric citrate, oral, 3 mg ferric iron, (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0609", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Fertility cycl tracking soft", "code_information": [{"code": "A9293", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under \"denominator note\" or the long-acting injectable antipsychotic medications listed under \"denominator note\"", "code_information": [{"code": "M1380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "First 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (DMHT) device that augments a behavioral therapy plan, physician/other qualified health care professional ti", "code_information": [{"code": "G0553", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Flurpiridaz F 18, diagnostic, 1 millicurie", "code_information": [{"code": "A9611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Foundation DRS Solo, per square centimeter", "code_information": [{"code": "A2034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G COMPRESSION BANDAGING", "code_information": [{"code": "A6609", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G COMPRESSION GARMENT", "code_information": [{"code": "A6549", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G STCKNG FULL/CHAP18-30 CUST", "code_information": [{"code": "A6559", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G STCKNG FULL/CHAP30-40 CUST", "code_information": [{"code": "A6560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G STOCKNG FULL/CHAP 40+ CUST", "code_information": [{"code": "A6561", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G-ESOPH REFLX TST W/ELECTROD", "code_information": [{"code": "91035", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G-TUBE 16FR 3-PORT", "code_information": [{"code": "3001184", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 52.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "G-TUBE 2-PORT 22FR 20CC BALLOON", "code_information": [{"code": "3001028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.42, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "G-TUBE 2-PORT18FR 20CC BALLOON", "code_information": [{"code": "3001029", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "G-TUBE 3-PORT 18FR 20CC", "code_information": [{"code": "3001030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "G-TUBE UNIVERSAL Y-SITE ADAPTER", "code_information": [{"code": "80000911", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "G6PC GENE", "code_information": [{"code": "81250", "type": "CPT"}], "standard_charges": [{"minimum": 67.26, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G6PD FULL GENE SEQUENCE", "code_information": [{"code": "81249", "type": "CPT"}], "standard_charges": [{"minimum": 690.0, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G6PD GENE ALYS CMN VARIANT", "code_information": [{"code": "81247", "type": "CPT"}], "standard_charges": [{"minimum": 201.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G6PD KNOWN FAMILIAL VARIANT", "code_information": [{"code": "81248", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 431.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 431.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "G6PD LEVELS", "code_information": [{"code": "82955", "type": "CPT"}, {"code": "1000616", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.16, "maximum": 51.65, "gross_charge": 57.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 45.91, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 32.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GA67 GALLIUM", "code_information": [{"code": "A9556", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GABAPENTIN NON-BLOOD", "code_information": [{"code": "80355", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAD-65 ANTOANTIBODY", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "1000490", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.16, "maximum": 71.98, "gross_charge": 79.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAD-BASE MR CONTRAST NOS,1ML", "code_information": [{"code": "A9579", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GADOBUTROL INJECTION", "code_information": [{"code": "A9585", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GADOFOSVESET TRISODIUM INJ", "code_information": [{"code": "A9583", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GADOXETATE DISODIUM INJ", "code_information": [{"code": "A9581", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAIT TRAINING THERAPY", "code_information": [{"code": "97116", "type": "CPT"}], "standard_charges": [{"minimum": 27.93, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 100.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALACTOSE TRANSFERASE TEST", "code_information": [{"code": "82776", "type": "CPT"}], "standard_charges": [{"minimum": 13.5, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALECTIN-3", "code_information": [{"code": "82777", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 50.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM GA-68", "code_information": [{"code": "A9587", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM GA-68 DOTATOC", "code_information": [{"code": "C9067", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM GA-68 PSMA-11 UCSF", "code_information": [{"code": "A9593", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM GA-68 PSMA-11, UCLA", "code_information": [{"code": "A9594", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM ILLUCCIX 1 MILLICURE", "code_information": [{"code": "A9596", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM LOCAMETZ 1 MILLICURI", "code_information": [{"code": "A9800", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM NITRATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1457", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALSULFASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1458", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAMMA GLOBULIN > 10 CC INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1560", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAMMA GLUTOMYL TRANS", "code_information": [{"code": "82977", "type": "CPT"}, {"code": "1000161", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.28, "maximum": 38.34, "gross_charge": 42.6, "discounted_cash": 54.17, "estimated_discounted_cash": 42.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 38.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAMMAGARD LIQUID INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1569", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAMMAGRAFT", "code_information": [{"code": "Q4111", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAMMAPLEX INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1557", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GANCICLOVIR LONG ACT IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7310", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GANCICLOVIR SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1570", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA AMP PROBE", "code_information": [{"code": "87511", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA DIR PROBE", "code_information": [{"code": "87510", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA QUANT", "code_information": [{"code": "87512", "type": "CPT"}], "standard_charges": [{"minimum": 48.02, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAS SYSTEM STATIONARY COMPRE", "code_information": [{"code": "E0425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC ANALY W/PH EA SPEC", "code_information": [{"code": "82930", "type": "CPT"}], "standard_charges": [{"minimum": 7.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS FOR OBESITY", "code_information": [{"code": "43846", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS INCL SMALL I", "code_information": [{"code": "43847", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78264", "type": "CPT"}], "standard_charges": [{"minimum": 392.58, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 392.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78265", "type": "CPT"}], "standard_charges": [{"minimum": 464.96, "maximum": 464.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 464.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78266", "type": "CPT"}], "standard_charges": [{"minimum": 521.51, "maximum": 521.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 521.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC LAVAG CLOSED 28FR", "code_information": [{"code": "3001273", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 154.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GASTRIC LAVAG CLOSED 34FR", "code_information": [{"code": "3001274", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 173.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GASTRIC LAVAGE CLOSED 18FR", "code_information": [{"code": "3001279", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 154.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GASTRIC MOTILITY STUDIES", "code_information": [{"code": "91020", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC MUCOSA IMAGING", "code_information": [{"code": "78261", "type": "CPT"}], "standard_charges": [{"minimum": 245.14, "maximum": 245.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 245.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIN", "code_information": [{"code": "82941", "type": "CPT"}, {"code": "1000618", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.27, "maximum": 103.37, "gross_charge": 104.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 83.52, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 93.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIN TEST", "code_information": [{"code": "82938", "type": "CPT"}], "standard_charges": [{"minimum": 20.34, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROENTEROLOGY SS", "code_information": [{"code": "G4006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX EXAM", "code_information": [{"code": "78262", "type": "CPT"}], "standard_charges": [{"minimum": 292.42, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 292.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX TEST", "code_information": [{"code": "91034", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROGRAFIN 66-10% SOLUTION", "drug_information": {"unit": 120.0, "type": "EA"}, "code_information": [{"code": "Q9963", "type": "HCPCS"}, {"code": "72001127", "type": "CDM"}, {"code": "00270044540", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 27.78, "maximum": 43.87, "gross_charge": 48.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 43.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL FAT ABSORPT", "code_information": [{"code": "S3708", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [{"code": "378", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [{"code": "377", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "379", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [{"code": "389", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [{"code": "388", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 2908.14, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC", "code_information": [{"code": "390", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43360", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43361", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY DUODENAL SWITCH", "code_information": [{"code": "43845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY W/O V-BAND", "code_information": [{"code": "43843", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROSTOMY TUBE CHG TECH", "code_information": [{"code": "43762", "type": "CPT"}, {"code": "11000049", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 392.49, "maximum": 619.73, "gross_charge": 688.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 516.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 550.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 619.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 392.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART MULTIPLE", "code_information": [{"code": "78473", "type": "CPT"}], "standard_charges": [{"minimum": 348.43, "maximum": 348.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 348.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR SINGLE", "code_information": [{"code": "78472", "type": "CPT"}], "standard_charges": [{"minimum": 274.08, "maximum": 274.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 274.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAUZE <= 16 SQ IN WATER/SAL", "code_information": [{"code": "A6228", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAUZE > 48 SQ IN W/BORDER", "code_information": [{"code": "A6221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAUZE > 48 SQ IN WATER/SALNE", "code_information": [{"code": "A6230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GAUZE PRECUT SPNG 4X4", "code_information": [{"code": "3001267", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GAUZE SPONGE 2X2 8PLY STERILE", "code_information": [{"code": "3001003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GAUZE SPONGE 4X4 12-PLY STERILE", "code_information": [{"code": "3000330", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GAUZE SPONGE 4X4 TUB STERILE", "code_information": [{"code": "3000331", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GAUZE VASELINE 3 X 9", "code_information": [{"code": "3000488", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GBA GENE", "code_information": [{"code": "81251", "type": "CPT"}], "standard_charges": [{"minimum": 54.34, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GC CHL SYP DOCUMENTED", "code_information": [{"code": "G9228", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GC STOCKING GARTER BELT", "code_information": [{"code": "A6544", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GC/CHLAMYDIA NAA AMPLIFICATION", "code_information": [{"code": "87491", "type": "CPT"}, {"code": "1000987", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 33.38, "maximum": 186.97, "gross_charge": 207.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 166.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 186.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 118.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GE GNOTYP GYPC EXONS 1-4", "code_information": [{"code": "188U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEBAUER'S ETHYL CHLORIDE SPRAY 100%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001090", "type": "CDM"}, {"code": "00386000102", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GEFITINIB ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8565", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEL-ONE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7326", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEL-T 17X17 W/NON-SKID COVER CUSHION", "code_information": [{"code": "3001228", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 82.42, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GELFOAM SG 12-7MM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3001291", "type": "CDM"}, {"code": "00409613922", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GELSYN-3 INJECTION 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7328", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEMTESA (VIBEGRON) 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004339", "type": "CDM"}, {"code": "73336007530", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 45.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GEMTUZUMAB OZOGAMICIN 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9203", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEN, NEURO, CAROT SINUS BARO", "code_information": [{"code": "C1825", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEN, NEURO, CLO LOOP, RECHG", "code_information": [{"code": "C1826", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEN, NEURO, HF, RECHG BAT", "code_information": [{"code": "C1822", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEN, NEURO, IMP LED, EX CNTR", "code_information": [{"code": "C1827", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEN, NEURO, TRANS SEN/STIM", "code_information": [{"code": "C1823", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE PROFILE PANEL BREAST", "code_information": [{"code": "S3854", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TEST ALPHA-THALASSEMIA", "code_information": [{"code": "S3845", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TEST BETA-THALASSEMIA", "code_information": [{"code": "S3846", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TEST HIPPEL-LINDAU", "code_information": [{"code": "S3842", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TEST MYO MUSCLR DYST", "code_information": [{"code": "S3853", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TEST NIEMANN-PICK", "code_information": [{"code": "S3849", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TEST RETINOBLASTOMA", "code_information": [{"code": "S3841", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TEST SICKLE CELL", "code_information": [{"code": "S3850", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TESTING NOT PERFORMED", "code_information": [{"code": "G9841", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENE TESTING PERFORMED", "code_information": [{"code": "G9840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENERAL ANESTH EA ADDL 15 MI", "code_information": [{"code": "D9223", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.72, "maximum": 112.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENERAL HEALTH PANEL", "code_information": [{"code": "80050", "type": "CPT"}], "standard_charges": [{"minimum": 26.51, "maximum": 42.05, "discounted_cash": 54.17, "estimated_discounted_cash": 186.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 90.54, "count": "13", "median_amount": 84.88, "methodology": "percent of total billed charges", "10th_percentile": 59.22, "90th_percentile": 118.01}], "billing_class": "facility"}]}, {"description": "GENERAL SURGERY SS", "code_information": [{"code": "G4007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENERATOR NEURO RECHG BAT SY", "code_information": [{"code": "C1820", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENERATOR, CCM, IMPLANT", "code_information": [{"code": "C1824", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENERATOR, NEURO NON-RECHARG", "code_information": [{"code": "C1767", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENESIS AMNIO MEMBRANE 1SQCM", "code_information": [{"code": "Q4198", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENETIC COUNSEL 15 MINS", "code_information": [{"code": "S0265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENETIC TEST BRUGADA", "code_information": [{"code": "S3861", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENETIC TEST SPEC ANALYSIS", "code_information": [{"code": "D0423", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENETIC TESTING ALS", "code_information": [{"code": "S3800", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENETIC TSTG SEVERE INH COND", "code_information": [{"code": "81443", "type": "CPT"}], "standard_charges": [{"minimum": 2815.84, "maximum": 2815.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2815.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENOM RPD SEQ ALYS EA CMPRTR", "code_information": [{"code": "425U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENOME RAPID SEQUENCE ALYS", "code_information": [{"code": "94U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENOME RE-EVALUATION", "code_information": [{"code": "81427", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENOME SEQUENCE ANALYSIS", "code_information": [{"code": "81425", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENOME SEQUENCE ANALYSIS", "code_information": [{"code": "81426", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENOME ULTRA-RAPID SEQ ALYS", "code_information": [{"code": "426U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN 0.1% CREAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000214", "type": "CDM"}, {"code": "00713068315", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 27.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GENTAMICIN PEAK", "code_information": [{"code": "80170", "type": "CPT"}, {"code": "1000363", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 87.31, "gross_charge": 97.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 87.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN SULF 0.3% OPTH SOL 5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000212", "type": "CDM"}, {"code": "61314063305", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 13.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GENTAMICIN SULFATE 80MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1580", "type": "HCPCS"}, {"code": "7000213", "type": "CDM"}, {"code": "63323001002", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN SULFATE 80MG/100ML NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1580", "type": "HCPCS"}, {"code": "72000935", "type": "CDM"}, {"code": "63323001002", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN TROUGH", "code_information": [{"code": "80170", "type": "CPT"}, {"code": "1000463", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 87.31, "gross_charge": 97.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 87.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENVISC 850, INJ, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7320", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEODON (ZIPRASIDONE HCL) CAP 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000557", "type": "CDM"}, {"code": "55111025660", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GEODON (ZIPRASIDONE) 20MG/ML INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J3486", "type": "HCPCS"}, {"code": "72000762", "type": "CDM"}, {"code": "72266016010", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 14.82, "maximum": 23.4, "gross_charge": 26.0, "discounted_cash": 54.17, "estimated_discounted_cash": 26.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 23.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GERD SYMPS ASSESSED 12 MONTH", "code_information": [{"code": "1118F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GERIATRICS SS", "code_information": [{"code": "G4008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GFRG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15774", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI BARET ESPH DNA MTHYLN ALY", "code_information": [{"code": "407U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI BARET ESPH DNA MTHYLN ALY", "code_information": [{"code": "409U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI BARRETT ESOPH 9 PRTN BMRK", "code_information": [{"code": "108U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI BARRETTS ESOPH VIM&CCNA1", "code_information": [{"code": "114U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI COCKTAIL (5 LIDO/10 DON/30 MYL) 45ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000190", "type": "CDM"}, {"code": "59212042216", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 54.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GI ENDOSCOPIC ULTRASOUND", "code_information": [{"code": "76975", "type": "CPT"}], "standard_charges": [{"minimum": 297.5, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI IBS IA ANTI-CDTB&VINCULIN", "code_information": [{"code": "164U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI MALABS AAT CALPRO PNCRTC", "code_information": [{"code": "430U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI MYOELECTRICAL ACTV STUDY", "code_information": [{"code": "779T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI PROPHYLAXIS FOR NSAID RX", "code_information": [{"code": "4017F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI PROTEIN LOSS EXAM", "code_information": [{"code": "78282", "type": "CPT"}], "standard_charges": [{"minimum": 464.67, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 464.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL COLON I&R", "code_information": [{"code": "91113", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL ESOPH-ILE", "code_information": [{"code": "91110", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL ESOPHAGUS", "code_information": [{"code": "91111", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI WIRELESS CAPSULE MEASURE", "code_information": [{"code": "91112", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GI/RENAL RISK ASSESS", "code_information": [{"code": "1008F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GIARDIA AG IF", "code_information": [{"code": "87269", "type": "CPT"}], "standard_charges": [{"minimum": 15.65, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GIARDIA LAMBLIA ANTIBODY", "code_information": [{"code": "86674", "type": "CPT"}], "standard_charges": [{"minimum": 16.93, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GIARDIA LAMBLIA DIRECT", "code_information": [{"code": "87329", "type": "CPT"}, {"code": "1099024", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.78, "maximum": 90.0, "gross_charge": 100.0, "discounted_cash": 54.17, "estimated_discounted_cash": 100.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GINGIVAL FLAP PROC W/ PLANIN", "code_information": [{"code": "D4240", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GINGIVAL IRRIGATION PER QUAD", "code_information": [{"code": "D4921", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GINGIVECTOMY/PLASTY 1 TO 3", "code_information": [{"code": "D4211", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GINGIVECTOMY/PLASTY 4 OR MOR", "code_information": [{"code": "D4210", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GINGIVECTOMY/PLASTY REST", "code_information": [{"code": "D4212", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE FULL SEQUENCE", "code_information": [{"code": "81252", "type": "CPT"}], "standard_charges": [{"minimum": 116.29, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 116.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81253", "type": "CPT"}], "standard_charges": [{"minimum": 70.75, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GJB6 GENE COM VARIANTS", "code_information": [{"code": "81254", "type": "CPT"}], "standard_charges": [{"minimum": 40.25, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLASSES AIR CONDUCTION", "code_information": [{"code": "V5070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLASSES BINAURAL HEARING AID", "code_information": [{"code": "V5150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLASSES BONE CONDUCTION", "code_information": [{"code": "V5080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLASSIA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0257", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA PLAN OF CARE DOC", "code_information": [{"code": "M1223", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA PLAN OF CARE DOCD", "code_information": [{"code": "517F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA PLN OF CARE NOT DOC", "code_information": [{"code": "M1222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0118", "type": "HCPCS"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66150", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66170", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLOBAL ESWL KIDNEY", "code_information": [{"code": "S0400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLOVES EXAM NON-STER", "code_information": [{"code": "3000195", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLOVES SURG SZ 6", "code_information": [{"code": "3000490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLOVES SURG SZ 6 1/2", "code_information": [{"code": "3000491", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLOVES SURG SZ 7", "code_information": [{"code": "3000493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLOVES SURG SZ 7 1/2", "code_information": [{"code": "3000492", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLOVES SURG SZ 8", "code_information": [{"code": "3000494", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLOVES SURG SZ 8 1/2", "code_information": [{"code": "3000495", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUC MONITOR PURCHASE", "code_information": [{"code": "S1030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUC MONITOR RENTAL", "code_information": [{"code": "S1031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUCAGEN (GLUCAGON) 1MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1610", "type": "HCPCS"}, {"code": "7000216", "type": "CDM"}, {"code": "00597026010", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 183.54, "maximum": 289.8, "gross_charge": 322.0, "discounted_cash": 54.17, "estimated_discounted_cash": 322.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 241.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 257.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 289.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 183.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE PANEL", "code_information": [{"code": "80422", "type": "CPT"}], "standard_charges": [{"minimum": 52.98, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 52.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE PANEL", "code_information": [{"code": "80424", "type": "CPT"}], "standard_charges": [{"minimum": 58.08, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE TEST", "code_information": [{"code": "82946", "type": "CPT"}], "standard_charges": [{"minimum": 20.44, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUCERNA SHAKE CHOCOLATE", "code_information": [{"code": "80001193", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCERNA SHAKE VANILLA", "code_information": [{"code": "80001192", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCO MNGMNT PLAN DOCD", "code_information": [{"code": "540F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUCOPHAGE (METFORMIN) ER TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000608", "type": "CDM"}, {"code": "70010049109", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCOPHAGE (METFORMIN) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000125", "type": "CDM"}, {"code": "00904716261", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCOPHAGE (METFORMIN) TAB 850MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000217", "type": "CDM"}, {"code": "00904716361", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCOSE", "code_information": [{"code": "82947", "type": "CPT"}, {"code": "1000164", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.52, "maximum": 20.89, "gross_charge": 23.22, "discounted_cash": 54.17, "estimated_discounted_cash": 23.22, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 18.57, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 20.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCOSE (DEXTROSE) 50% SYRINGE 50ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7060", "type": "HCPCS"}, {"code": "72000161", "type": "CDM"}, {"code": "00409751716", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 23.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCOSE BLOOD TEST", "code_information": [{"code": "82962", "type": "CPT"}], "standard_charges": [{"minimum": 3.77, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUCOSE PASTE 15GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000247", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCOSE- BODY FLUID", "code_information": [{"code": "82945", "type": "CPT"}, {"code": "1000700", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.52, "maximum": 20.89, "gross_charge": 23.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 18.57, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 20.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCOTROL (GLIPIZIDE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000361", "type": "CDM"}, {"code": "00904663761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCOTROL XL (GLIPIZIDE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000215", "type": "CDM"}, {"code": "68084011101", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCOTROL XL (NF-GLIPIZIDE ER) 2.5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002751", "type": "CDM"}, {"code": "59651026830", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUCOVANCE TAB 5/500", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000367", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLUTAMINE ORAL POWDER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001159", "type": "CDM"}, {"code": "62991288202", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLY RCPTR ALPHA1 IGG SRM/CSF", "code_information": [{"code": "431U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLYBURIDE MICRO TAB 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000613", "type": "CDM"}, {"code": "00378112501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLYBURIDE TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000473", "type": "CDM"}, {"code": "00093834301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLYCA NUC MR SPECTRSC QUAN", "code_information": [{"code": "24U", "type": "CPT"}], "standard_charges": [{"minimum": 102.04, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLYCERIN SUPPOSITORY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000416", "type": "CDM"}, {"code": "54868618600", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GLYCOMARK", "code_information": [{"code": "84378", "type": "CPT"}, {"code": "1000926", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 57.69, "gross_charge": 64.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 51.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLYCOPYRROLATE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLYCOPYRROLATE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7643", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GNGVL FLAP W ROOTPLAN 1-3 TH", "code_information": [{"code": "D4241", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GOLD BOND MEDICATED BODY POWDER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001131", "type": "CDM"}, {"code": "41167006800", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.67, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GOLD SODIUM THIOMALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GOLIMUMAB FOR IV USE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1602", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GOLYTELY PWD FOR SOLN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001089", "type": "CDM"}, {"code": "52268010001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 22.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GOMCO PUMP", "code_information": [{"code": "3000632", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GONADORELIN HYDROCH/ 100 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GONADOTROPIN HORMONE PANEL", "code_information": [{"code": "80426", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 170.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 170.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GONIOSCOPY", "code_information": [{"code": "92020", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GOSERELIN ACETATE IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9202", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GOWN ISOLATION DISPOSABLE", "code_information": [{"code": "3000196", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 40.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GR 2 OR> DIA OR GR2 OR> COL", "code_information": [{"code": "M1181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GR 34 NONSEALED LEADACID", "code_information": [{"code": "E2358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAD COM ACCESSORY GMT_WRAP", "code_information": [{"code": "A6593", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAD COM WRAP W STRAPS", "code_information": [{"code": "A6584", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRADIENT PRESSURE WRAP", "code_information": [{"code": "S8429", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFIX CORE, GRAFIXPL CORE", "code_information": [{"code": "Q4132", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFIX PLUS, PER SQ CM", "code_information": [{"code": "Q4304", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFIX STRAVIX PRIME PL SQCM", "code_information": [{"code": "Q4133", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFT HAND OR FINGER TENDON", "code_information": [{"code": "26416", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFT REPAIR OF SPINE DEFECT", "code_information": [{"code": "63710", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFT, VASCULAR", "code_information": [{"code": "C1768", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET", "code_information": [{"code": "Q4107", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET XPRESS", "code_information": [{"code": "Q4113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "1000116", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 4.91, "maximum": 23.08, "gross_charge": 25.26, "discounted_cash": 54.17, "estimated_discounted_cash": 25.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANISETRON 1MG", "code_information": [{"code": "S0091", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRANISETRON HCL 1 MG ORAL", "code_information": [{"code": "Q0166", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRANISETRON HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRANULOCYTES, PHERESIS UNIT", "code_information": [{"code": "P9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAVITY GAVAGE SET", "code_information": [{"code": "3000499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GRAVLEE JET WASHER", "code_information": [{"code": "A4470", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GREAT TOE-HAND TRANSFER", "code_information": [{"code": "26551", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 25 CC/<", "code_information": [{"code": "15773", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 50 CC/<", "code_information": [{"code": "15771", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15772", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL SOFT TISS DIR EXC", "code_information": [{"code": "15769", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRFT, TRNSMURL/TRNSVENS BYPS", "code_information": [{"code": "C1604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRIPS HAND FOR CRUTCH", "code_information": [{"code": "3000197", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GROSS EXAM, PREP & REPORT", "code_information": [{"code": "D0472", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROSS PULPAL DEBRIDEMENT", "code_information": [{"code": "D3221", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROUND MILEAGE", "code_information": [{"code": "A0425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROUP BEHAVE COUNS 2-10", "code_information": [{"code": "G0473", "type": "HCPCS"}], "standard_charges": [{"minimum": 627.29, "maximum": 627.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 627.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROUP CAREGIVER TRAINING", "code_information": [{"code": "97552", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROUP HEALTH EDUCATION", "code_information": [{"code": "99078", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROUP MNT 2 OR MORE 30 MINS", "code_information": [{"code": "G0271", "type": "HCPCS"}], "standard_charges": [{"minimum": 627.29, "maximum": 627.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 627.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROUP PSYCHOTHERAPY", "code_information": [{"code": "90853", "type": "CPT"}], "standard_charges": [{"minimum": 683.18, "maximum": 683.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 683.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROUP THERAPEUTIC PROCEDURES", "code_information": [{"code": "97150", "type": "CPT"}], "standard_charges": [{"minimum": 16.77, "maximum": 16.77, "discounted_cash": 54.17, "estimated_discounted_cash": 52.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE", "code_information": [{"code": "83003", "type": "CPT"}, {"code": "1000092", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.17, "maximum": 103.37, "gross_charge": 98.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 78.93, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 88.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE ANTIBODY", "code_information": [{"code": "86277", "type": "CPT"}], "standard_charges": [{"minimum": 18.1, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE PANEL", "code_information": [{"code": "80428", "type": "CPT"}], "standard_charges": [{"minimum": 76.71, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 76.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE PANEL", "code_information": [{"code": "80430", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 148.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 148.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GROWTH STIMULATION GENE 2", "code_information": [{"code": "83006", "type": "CPT"}], "standard_charges": [{"minimum": 86.94, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 86.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRP A STREP TEST PERFORMED", "code_information": [{"code": "3210F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRP ADAPT BHV TX BY PHY/QHP", "code_information": [{"code": "97158", "type": "CPT"}], "standard_charges": [{"minimum": 15.07, "maximum": 15.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRP ADAPT BHV TX BY TECH", "code_information": [{"code": "97154", "type": "CPT"}], "standard_charges": [{"minimum": 11.51, "maximum": 11.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRP B STREP SCREENING DOCD", "code_information": [{"code": "3294F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRP PSYCH PHP/IOP 45-50", "code_information": [{"code": "G0410", "type": "HCPCS"}], "standard_charges": [{"minimum": 683.18, "maximum": 683.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 683.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GSTR EMPTG 7 TIMED BRTH SPEC", "code_information": [{"code": "106U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GTT 1HR", "code_information": [{"code": "82950", "type": "CPT"}, {"code": "1000165", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.46, "maximum": 25.29, "gross_charge": 28.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 22.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GTT 2 HOUR - (3 SPECIMENS)", "code_information": [{"code": "82951", "type": "CPT"}, {"code": "1000167", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.8, "maximum": 68.58, "gross_charge": 76.2, "discounted_cash": 54.17, "estimated_discounted_cash": 76.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 60.96, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GTT ADDITIONAL SPECIMEN", "code_information": [{"code": "82952", "type": "CPT"}, {"code": "1000168", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.51, "maximum": 38.72, "gross_charge": 23.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 20.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUAIFENESIN 400MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001135", "type": "CDM"}, {"code": "00536131108", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GUAIFENESIN AC SOLN 10MG-100MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001730", "type": "CDM"}, {"code": "69367027204", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "GUIDANCE FOR RADJ TX DLVR", "code_information": [{"code": "77387", "type": "CPT"}], "standard_charges": [{"minimum": 203.88, "maximum": 203.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 203.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GUIDE NERV DESTR ELEC STIM", "code_information": [{"code": "95873", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GUIDE NERV DESTR NEEDLE EMG", "code_information": [{"code": "95874", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GUIDED TISS REGEN NONRESORB", "code_information": [{"code": "D4267", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GUIDED TISS REGEN RESORBLE", "code_information": [{"code": "D4266", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GUIDED TISSUE REGENERATION", "code_information": [{"code": "D3432", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GUM GRAFT", "code_information": [{"code": "41870", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GYPA GNOTYP NTRNS 1 5 EXON 2", "code_information": [{"code": "189U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GYPB GNOTYP NTRNS 1 5 SEUX 3", "code_information": [{"code": "190U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gait modulation system, rhythmic auditory stimulation, including restricted therapy software, all components and accessories, prescription only", "code_information": [{"code": "E3200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gastroenterology (Barrett's esophagus), esophageal cells, DNA methylation analysis by next-generation sequencing of at least 89 differentially methylated genomic regions, algorithm reported as likelihood for Barrett's esophagus", "code_information": [{"code": "506U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gastroenterology (irritable bowel disease [IBD]), immunoassay for quantitative determination of adalimumab (ADL) levels in venous serum in patients undergoing adalimumab therapy, results reported as a numerical value as micrograms per milliliter (\u00b5g/mL)", "code_information": [{"code": "514U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gastroenterology (irritable bowel disease [IBD]), immunoassay for quantitative determination of infliximab (IFX) levels in venous serum in patients undergoing infliximab therapy, results reported as a numerical value as micrograms per milliliter (\u00b5g/mL)", "code_information": [{"code": "515U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gastroenterology care MIPS value pathway", "code_information": [{"code": "M1422", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Glial fibrillary acidic protein (GFAP), chemiluminescent enzyme immunoassay, using plasma", "code_information": [{"code": "548U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Glucose monitor w cartridge", "code_information": [{"code": "E2104", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gradient compression garment, not otherwise specified, for nighttime use, each", "code_information": [{"code": "A6519", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gradient compression wrap with adjustable straps, above knee, each, custom", "code_information": [{"code": "A6611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gradient compression wrap with adjustable straps, arm, each, custom", "code_information": [{"code": "A6518", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gradient compression wrap with adjustable straps, below knee, each, custom", "code_information": [{"code": "A6517", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gradient compression wrap with adjustable straps, foot, each, custom", "code_information": [{"code": "A6516", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Gradient compression wrap with adjustable straps, full leg, each, custom", "code_information": [{"code": "A6515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Graphite crucible for preparation of technetium TC 99m-labeled carbon aerosol, one crucible", "code_information": [{"code": "A9506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Group caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, an", "code_information": [{"code": "G0543", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "H PYLORI (C-13) BLOOD", "code_information": [{"code": "83009", "type": "CPT"}], "standard_charges": [{"minimum": 77.46, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 77.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "H PYLORI (C-13) BREATH", "code_information": [{"code": "83013", "type": "CPT"}], "standard_charges": [{"minimum": 77.46, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 77.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "H PYLORI AB QUAL-RAPID", "code_information": [{"code": "87338", "type": "CPT"}, {"code": "1000032", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.54, "maximum": 56.7, "gross_charge": 63.0, "discounted_cash": 54.17, "estimated_discounted_cash": 62.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 56.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 35.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI AG IA", "code_information": [{"code": "87339", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "H PYLORI DRUG ADMIN", "code_information": [{"code": "83014", "type": "CPT"}], "standard_charges": [{"minimum": 9.04, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "H PYLORI IgG AB", "code_information": [{"code": "86677", "type": "CPT"}, {"code": "1000712", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.38, "maximum": 96.7, "gross_charge": 85.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 48.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI IgM IgG IgA ANTIBODIES", "code_information": [{"code": "86677", "type": "CPT"}, {"code": "1000713", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.38, "maximum": 96.7, "gross_charge": 85.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 48.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H PYLORI STOOL ANTIGEN", "code_information": [{"code": "87338", "type": "CPT"}, {"code": "1000547", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.54, "maximum": 53.27, "gross_charge": 59.19, "discounted_cash": 54.17, "estimated_discounted_cash": 62.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 47.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 53.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 33.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "H&P FOR SURGERY", "code_information": [{"code": "S0260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "H2O STAT DOCD DEHYDRATED", "code_information": [{"code": "2031F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "H2O STAT DOCD NORMAL", "code_information": [{"code": "2030F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAB PREVO WAIVER PER 15", "code_information": [{"code": "T2047", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABERMAN FEEDER", "code_information": [{"code": "S8265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABIL ED WAIVER PER HOUR", "code_information": [{"code": "T2013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABIL ED WAIVER, PER DIEM", "code_information": [{"code": "T2012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABIL PREVOC WAIVER PER HR", "code_information": [{"code": "T2015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABIL PREVOC WAIVER, PER D", "code_information": [{"code": "T2014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABIL RES WAIVER 15 MIN", "code_information": [{"code": "T2017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABIL RES WAIVER PER DIEM", "code_information": [{"code": "T2016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABIL SUP EMPL WAIVER 15MIN", "code_information": [{"code": "T2019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HABIL SUP EMPL WAIVER/DIEM", "code_information": [{"code": "T2018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAD SMOKE B/4 ANES DAY SURG", "code_information": [{"code": "G9645", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAIR ANALYSIS", "code_information": [{"code": "P2031", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.73, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAIR REMOVAL BY ELECTROLYSIS", "code_information": [{"code": "17380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL 1-15 PUNCH GRFTS", "code_information": [{"code": "15775", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL >15 PUNCH GRAFTS", "code_information": [{"code": "15776", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HALCION (TRINZOLAM) TAB 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000292", "type": "CDM"}, {"code": "00009001755", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HALDOL (HALOPERIDOL) 5MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1630", "type": "HCPCS"}, {"code": "7200071", "type": "CDM"}, {"code": "63323047401", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 10.26, "maximum": 16.2, "gross_charge": 18.0, "discounted_cash": 54.17, "estimated_discounted_cash": 27.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALDOL (HALOPERIDOL) TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000219", "type": "CDM"}, {"code": "51079073420", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HALDOL (HALOPERIDOL) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000220", "type": "CDM"}, {"code": "68382007901", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HALOPERIDOL DECANOATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HALTER HEAD UNIVERSAL", "code_information": [{"code": "3000198", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HAND HELD LOW VISION AIDS", "code_information": [{"code": "V2600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "513", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "514", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HAND PROCEDURES FOR INJURIES", "code_information": [{"code": "906", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26500", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26502", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAND TENDON/MUSCLE TRANSFER", "code_information": [{"code": "26494", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAND/BODY LOTION", "code_information": [{"code": "3001326", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HAPTOGLOBIN", "code_information": [{"code": "83010", "type": "CPT"}, {"code": "1000053", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.47, "maximum": 67.01, "gross_charge": 74.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 59.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 67.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 42.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST ALLOGENEIC STEM CELL", "code_information": [{"code": "38205", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HARVEST AUTO STEM CELLS", "code_information": [{"code": "38206", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HARVEST CULTURED SKIN GRAFT", "code_information": [{"code": "15040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HARVEST EYE TISSUE ALOGRAFT", "code_information": [{"code": "68371", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HARVEST FEMOROPOPLITEAL VEIN", "code_information": [{"code": "35572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HARVEST STEM CELL CONCENTRTE", "code_information": [{"code": "38215", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HARVEST VEIN FOR BYPASS", "code_information": [{"code": "35500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HARVESTING OF DONOR MULTIVIS", "code_information": [{"code": "S2055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAST W/OXYGEN TITRATE", "code_information": [{"code": "94453", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HAST W/REPORT", "code_information": [{"code": "94452", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HB GLYCOSYLATED A1C HOME DEV", "code_information": [{"code": "83037", "type": "CPT"}], "standard_charges": [{"minimum": 11.17, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 FULL GENE SEQUENCE", "code_information": [{"code": "81259", "type": "CPT"}], "standard_charges": [{"minimum": 690.0, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE", "code_information": [{"code": "81257", "type": "CPT"}], "standard_charges": [{"minimum": 117.6, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE DUP/DEL VRNTS", "code_information": [{"code": "81269", "type": "CPT"}], "standard_charges": [{"minimum": 232.76, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE FAM VRNT", "code_information": [{"code": "81258", "type": "CPT"}], "standard_charges": [{"minimum": 431.54, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 431.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBA1C IN OFFICE TESTING", "code_information": [{"code": "D0411", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBB FULL GENE SEQUENCE", "code_information": [{"code": "81364", "type": "CPT"}], "standard_charges": [{"minimum": 373.27, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 373.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBB GENE COM VARIANTS", "code_information": [{"code": "81361", "type": "CPT"}], "standard_charges": [{"minimum": 201.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBB GENE DUP/DEL VARIANTS", "code_information": [{"code": "81363", "type": "CPT"}], "standard_charges": [{"minimum": 232.76, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBB GENE KNOWN FAM VARIANT", "code_information": [{"code": "81362", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 431.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 431.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBOT, FULL BODY CHAMBER, 30M", "code_information": [{"code": "G0277", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBV ASSESS&RESULTS INTRP 1YR", "code_information": [{"code": "3517F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HBV STATUS ASSESED AND INT", "code_information": [{"code": "G9912", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HC PRO PHONE CALL 11-20 MIN", "code_information": [{"code": "98967", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HC PRO PHONE CALL 21-30 MIN", "code_information": [{"code": "98968", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HC PRO PHONE CALL 5-10 MIN", "code_information": [{"code": "98966", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HCG BETA SUBUNIT QNT", "code_information": [{"code": "84702", "type": "CPT"}, {"code": "1000471", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.31, "maximum": 80.19, "gross_charge": 89.1, "discounted_cash": 54.17, "estimated_discounted_cash": 94.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 71.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 80.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HCG FREE BETACHAIN TEST", "code_information": [{"code": "84704", "type": "CPT"}], "standard_charges": [{"minimum": 17.58, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HCG SERUM QUAL", "code_information": [{"code": "84703", "type": "CPT"}, {"code": "1000250", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.65, "maximum": 80.19, "gross_charge": 89.1, "discounted_cash": 54.17, "estimated_discounted_cash": 89.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 71.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 80.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HCV ANTIBODY", "code_information": [{"code": "86803", "type": "CPT"}, {"code": "1000039", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.41, "maximum": 96.7, "gross_charge": 84.48, "discounted_cash": 54.17, "estimated_discounted_cash": 84.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 67.58, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 76.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 48.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HCV QUALITATIVE RNA BY NAA", "code_information": [{"code": "87521", "type": "CPT"}, {"code": "1000280", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 40.35, "maximum": 186.97, "gross_charge": 207.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 166.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 186.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 118.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HCV RNA BY PCR", "code_information": [{"code": "87522", "type": "CPT"}, {"code": "1000848", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 49.27, "maximum": 222.3, "gross_charge": 247.0, "discounted_cash": 54.17, "estimated_discounted_cash": 247.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 197.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 222.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 140.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HD BED TILTED 1ST DAY VENT", "code_information": [{"code": "4167F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR ELCTR NTRST/NTRCV BRCHTX", "code_information": [{"code": "395T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR ELCTR NTRST/NTRCV BRCHTX", "code_information": [{"code": "400U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR ELCTRNC SKN SURF BRCHYTX", "code_information": [{"code": "394T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR ELCTRNC SKN SURF BRCHYTX", "code_information": [{"code": "395U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77770", "type": "CPT"}], "standard_charges": [{"minimum": 557.21, "maximum": 557.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 557.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77771", "type": "CPT"}], "standard_charges": [{"minimum": 961.25, "maximum": 961.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 961.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77772", "type": "CPT"}], "standard_charges": [{"minimum": 1427.87, "maximum": 1427.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL SKN SURF BRACHYTX", "code_information": [{"code": "77767", "type": "CPT"}], "standard_charges": [{"minimum": 397.04, "maximum": 397.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 397.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL SKN SURF BRACHYTX", "code_information": [{"code": "77768", "type": "CPT"}], "standard_charges": [{"minimum": 578.07, "maximum": 578.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 578.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDTRANS BENCH W/WO COMM OPEN", "code_information": [{"code": "E0248", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEA CARE PRACT TX IN PLACE", "code_information": [{"code": "G2021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEAD IMMOBIL (DISP)", "code_information": [{"code": "3000199", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HEADACHES WITH MCC", "code_information": [{"code": "102", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEADACHES WITHOUT MCC", "code_information": [{"code": "103", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEALTH CLUB MEMBERSHIP YR", "code_information": [{"code": "S9970", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID BINAURAL BTE/BTE", "code_information": [{"code": "V5221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID BINAURAL GLASSES", "code_information": [{"code": "V5230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID BINAURAL ITC/BTE", "code_information": [{"code": "V5215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID BINAURAL ITC/ITC", "code_information": [{"code": "V5214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID BINAURAL ITE/BTE", "code_information": [{"code": "V5213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID BINAURAL ITE/ITC", "code_information": [{"code": "V5212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID BINAURAL ITE/ITE", "code_information": [{"code": "V5211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID CHECK BOTH EARS", "code_information": [{"code": "92593", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID CHECK ONE EAR", "code_information": [{"code": "92592", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID DISPENSING FEE", "code_information": [{"code": "V5090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID DISPENSING FEE", "code_information": [{"code": "V5110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM BOTH EARS", "code_information": [{"code": "92591", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM ONE EAR", "code_information": [{"code": "92590", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID FITTING/CHECKING", "code_information": [{"code": "V5011", "type": "HCPCS"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID MONAURAL BTE", "code_information": [{"code": "V5181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID MONAURAL GLASSES", "code_information": [{"code": "V5190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID MONAURAL IN EAR", "code_information": [{"code": "V5050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID MONAURAL ITC", "code_information": [{"code": "V5172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID MONAURAL ITE", "code_information": [{"code": "V5171", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID NOC", "code_information": [{"code": "V5298", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID REPAIR/MODIFYING", "code_information": [{"code": "V5014", "type": "HCPCS"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID SUP/ACCESS/DEV", "code_information": [{"code": "V5267", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, BINAURAL, CIC", "code_information": [{"code": "V5248", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, BINAURAL, ITC", "code_information": [{"code": "V5249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DIGIT, BIN, BTE", "code_information": [{"code": "V5261", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DIGIT, BIN, CIC", "code_information": [{"code": "V5258", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DIGIT, BIN, ITC", "code_information": [{"code": "V5259", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DIGIT, BIN, ITE", "code_information": [{"code": "V5260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DIGIT, MON, BTE", "code_information": [{"code": "V5257", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DIGIT, MON, ITC", "code_information": [{"code": "V5255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DIGIT, MON, ITE", "code_information": [{"code": "V5256", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DISP, BINAURAL", "code_information": [{"code": "V5263", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, DISP, MONAURAL", "code_information": [{"code": "V5262", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, MONAURAL, CIC", "code_information": [{"code": "V5242", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, MONAURAL, ITC", "code_information": [{"code": "V5243", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, PROG, BIN, BTE", "code_information": [{"code": "V5253", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, PROG, BIN, CIC", "code_information": [{"code": "V5250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, PROG, BIN, ITC", "code_information": [{"code": "V5251", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, PROG, BIN, ITE", "code_information": [{"code": "V5252", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, PROG, MON, BTE", "code_information": [{"code": "V5247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, PROG, MON, CIC", "code_information": [{"code": "V5244", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, PROG, MON, ITC", "code_information": [{"code": "V5245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID, PROG, MON, ITE", "code_information": [{"code": "V5246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING ID, DIGIT, MON, CIC", "code_information": [{"code": "V5254", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS DUP/DEL ANALYS", "code_information": [{"code": "81431", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 781.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 781.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS SEQUENCE ANALYS", "code_information": [{"code": "81430", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1868.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1868.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING SCREENING", "code_information": [{"code": "V5008", "type": "HCPCS"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING SERVICE", "code_information": [{"code": "V5299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [{"code": "292", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [{"code": "291", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 2890.12, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITHOUT CC/MCC", "code_information": [{"code": "293", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 2229.69, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE COMPOSITE", "code_information": [{"code": "1F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS ADD-ON", "code_information": [{"code": "78496", "type": "CPT"}], "standard_charges": [{"minimum": 54.93, "maximum": 54.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS MULTIPLE", "code_information": [{"code": "78483", "type": "CPT"}], "standard_charges": [{"minimum": 294.5, "maximum": 294.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 294.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS SINGLE", "code_information": [{"code": "78481", "type": "CPT"}], "standard_charges": [{"minimum": 215.58, "maximum": 215.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 215.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93571", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART IMAGE SPECT", "code_information": [{"code": "78494", "type": "CPT"}], "standard_charges": [{"minimum": 276.84, "maximum": 3077.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 276.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3077.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE", "code_information": [{"code": "78466", "type": "CPT"}], "standard_charges": [{"minimum": 233.15, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 233.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (3D)", "code_information": [{"code": "78469", "type": "CPT"}], "standard_charges": [{"minimum": 265.88, "maximum": 265.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 265.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (EF)", "code_information": [{"code": "78468", "type": "CPT"}], "standard_charges": [{"minimum": 236.22, "maximum": 236.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART PACING MAPPING", "code_information": [{"code": "93631", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART REVASCULARIZE (TMR)", "code_information": [{"code": "33140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART RHYTHM PACING", "code_information": [{"code": "93618", "type": "CPT"}], "standard_charges": [{"minimum": 19778.37, "maximum": 19778.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19778.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR", "code_information": [{"code": "331T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR SPECT", "code_information": [{"code": "332T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART TMR W/OTHER PROCEDURE", "code_information": [{"code": "33141", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [{"code": "1", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [{"code": "2", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEAT PAD NECK COLLAR", "code_information": [{"code": "3000200", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HEAT PAD TREATMENT LG BLUE", "code_information": [{"code": "3000201", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 34.02, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HEAT QUANT SENSORY TEST", "code_information": [{"code": "109T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEATING PAD", "code_information": [{"code": "3000634", "type": "CDM"}, {"code": "291", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HEAVY DUTY BATTERY", "code_information": [{"code": "A4611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL PROFILE 1 BLOOD", "code_information": [{"code": "82175", "type": "CPT"}, {"code": "1000852", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.82, "maximum": 101.06, "gross_charge": 112.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 89.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL PROFILE II-24 HR URINE", "code_information": [{"code": "82175", "type": "CPT"}, {"code": "1000783", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.82, "maximum": 101.06, "gross_charge": 112.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 89.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUAL ANY ANAL", "code_information": [{"code": "83015", "type": "CPT"}], "standard_charges": [{"minimum": 24.08, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEEL & ELBOW PROTECTOR", "code_information": [{"code": "3000202", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 19.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HEEL PAD (X-LARGE)", "code_information": [{"code": "3000203", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HEEL PAD MED ORTHO SPUR", "code_information": [{"code": "3001145", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HEINZ BODIES DIRECT", "code_information": [{"code": "85441", "type": "CPT"}], "standard_charges": [{"minimum": 4.83, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEINZ BODIES INDUCED", "code_information": [{"code": "85445", "type": "CPT"}], "standard_charges": [{"minimum": 7.84, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HELICOLL, PER SQUARE CM", "code_information": [{"code": "Q4164", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HELMINTH ANTIBODY", "code_information": [{"code": "86682", "type": "CPT"}], "standard_charges": [{"minimum": 14.96, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HELPER/SUPPRESSOR NATURAL KILLER CELL P", "code_information": [{"code": "86357", "type": "CPT"}, {"code": "1000950", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 43.39, "maximum": 200.96, "gross_charge": 223.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 178.63, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 200.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 127.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM AHUS GEN SEQ ALYS 15 GEN", "code_information": [{"code": "268U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM AUT DM CGEN TRMBCTPNA 22", "code_information": [{"code": "269U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM CGEN COAGJ DO 20 GENES", "code_information": [{"code": "270U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM CGEN NEUTROPENIA 24 GEN", "code_information": [{"code": "271U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM GEN HYPRFIBRNLYSIS 8 GEN", "code_information": [{"code": "273U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM GEN PLTLT DO 62 GENES", "code_information": [{"code": "274U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM GEN PLTLT FUNCJ DO 40", "code_information": [{"code": "277U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM GEN THROMBOSIS 14 GENES", "code_information": [{"code": "278U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM GENETIC BLD DO 60 GENES", "code_information": [{"code": "272U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM HEPRN NDUC TRMBCTPNA SRM", "code_information": [{"code": "275U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM INH THROMBOCYTOPENIA 42", "code_information": [{"code": "276U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM RBC ADS WHL BLD HYPOXIC", "code_information": [{"code": "303U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM RBC ADS WHL BLD NORMOXIC", "code_information": [{"code": "304U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM RBC FNCLTY&DFRM SHR STRS", "code_information": [{"code": "305U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM VW FACTOR&CLGN III BNDG", "code_information": [{"code": "279U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM VW FACTOR&CLGN IV BNDG", "code_information": [{"code": "280U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEM VWD PROPEPTIDE AG LVL", "code_information": [{"code": "281U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMAGGLUTINATION INHIBITION", "code_information": [{"code": "86280", "type": "CPT"}], "standard_charges": [{"minimum": 9.42, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMATOCRIT", "code_information": [{"code": "85014", "type": "CPT"}, {"code": "1000083", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.73, "maximum": 17.93, "gross_charge": 14.01, "discounted_cash": 54.17, "estimated_discounted_cash": 14.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMATOPOIETIC NUCLEAR TX", "code_information": [{"code": "79403", "type": "CPT"}], "standard_charges": [{"minimum": 206.43, "maximum": 996.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 206.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 996.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMI-WHEELCHAIR DETACHABLE A", "code_information": [{"code": "E1086", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMI-WHEELCHAIR FIXED ARMS", "code_information": [{"code": "E1085", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMICRT INTRCLRY ALGRFT PRTL", "code_information": [{"code": "20933", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1640", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS ACCESS STUDY", "code_information": [{"code": "90940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS MACHINE", "code_information": [{"code": "E1590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS ONE EVALUATION", "code_information": [{"code": "90935", "type": "CPT"}], "standard_charges": [{"minimum": 2442.42, "maximum": 2442.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2442.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS PLAN DOCD", "code_information": [{"code": "505F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS REPEATED EVAL", "code_information": [{"code": "90937", "type": "CPT"}], "standard_charges": [{"minimum": 2442.42, "maximum": 2442.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2442.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS VIA AV FISTULA", "code_information": [{"code": "4052F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS VIA AV GRAFT", "code_information": [{"code": "4053F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS VIA CATHETER", "code_information": [{"code": "4054F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN", "code_information": [{"code": "85018", "type": "CPT"}, {"code": "1000084", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.73, "maximum": 17.93, "gross_charge": 14.01, "discounted_cash": 54.17, "estimated_discounted_cash": 14.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN A1C", "code_information": [{"code": "83036", "type": "CPT"}, {"code": "1000042", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.17, "maximum": 49.0, "gross_charge": 54.45, "discounted_cash": 54.17, "estimated_discounted_cash": 54.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 43.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN A1C LEVEL >9.0%", "code_information": [{"code": "3046F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN A1C LEVEL >9.0%", "code_information": [{"code": "M1211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN CHROMOTOGRAPHY", "code_information": [{"code": "83021", "type": "CPT"}], "standard_charges": [{"minimum": 20.77, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN COPPER SULFATE", "code_information": [{"code": "83026", "type": "CPT"}], "standard_charges": [{"minimum": 4.61, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN F FETAL CHEMICAL", "code_information": [{"code": "83030", "type": "CPT"}], "standard_charges": [{"minimum": 12.35, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FETAL", "code_information": [{"code": "85460", "type": "CPT"}], "standard_charges": [{"minimum": 8.89, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FETAL", "code_information": [{"code": "85461", "type": "CPT"}], "standard_charges": [{"minimum": 10.76, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FTL F ASSAY QUAL", "code_information": [{"code": "83033", "type": "CPT"}], "standard_charges": [{"minimum": 9.2, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN PLASMA", "code_information": [{"code": "83051", "type": "CPT"}], "standard_charges": [{"minimum": 8.41, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN SOLUBILITY", "code_information": [{"code": "85660", "type": "CPT"}, {"code": "1000091", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 6.34, "maximum": 29.4, "gross_charge": 32.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 26.13, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 18.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN THERMOLABILE", "code_information": [{"code": "83065", "type": "CPT"}], "standard_charges": [{"minimum": 10.35, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN UNSTABLE SCREEN", "code_information": [{"code": "83068", "type": "CPT"}], "standard_charges": [{"minimum": 10.89, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN URINE", "code_information": [{"code": "83069", "type": "CPT"}], "standard_charges": [{"minimum": 4.54, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN-OXYGEN AFFINITY", "code_information": [{"code": "82820", "type": "CPT"}], "standard_charges": [{"minimum": 15.34, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOLYSIN ACID", "code_information": [{"code": "85475", "type": "CPT"}], "standard_charges": [{"minimum": 10.2, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS AUTO", "code_information": [{"code": "86940", "type": "CPT"}], "standard_charges": [{"minimum": 10.09, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOPERFUSION", "code_information": [{"code": "90997", "type": "CPT"}], "standard_charges": [{"minimum": 2442.42, "maximum": 2442.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2442.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOPHILIA CLOT FACTOR NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7199", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOPHILUS INFLUENZA ANTIBDY", "code_information": [{"code": "86684", "type": "CPT"}], "standard_charges": [{"minimum": 18.22, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDOPEXY BY STAPLING", "code_information": [{"code": "46947", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOSTATIC AGENT, GI, TOPIC", "code_information": [{"code": "C1052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOSTATS FOR DIALYSIS, EACH", "code_information": [{"code": "E1637", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP A Ab TOTAL", "code_information": [{"code": "86708", "type": "CPT"}, {"code": "1000671", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.25, "maximum": 65.98, "gross_charge": 73.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 65.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 41.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP A VAC INJXN ADMIN/RECVD", "code_information": [{"code": "4148F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP A VAC SERIES PREV RECVD", "code_information": [{"code": "4155F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP A/HEP B VACC ADULT IM", "code_information": [{"code": "90636", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP B CORE AB+ IgG & IgM DIFFERENTIATION", "code_information": [{"code": "86704", "type": "CPT"}, {"code": "1000278", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 74.7, "gross_charge": 83.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 66.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 47.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP B CORE ANTIBODY IGM", "code_information": [{"code": "86705", "type": "CPT"}], "standard_charges": [{"minimum": 13.54, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP B IG IM", "code_information": [{"code": "90371", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP B SCRNG DOCD AS DONE", "code_information": [{"code": "3513F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP B SURFACE AG NEUTRLZJ IA", "code_information": [{"code": "87341", "type": "CPT"}], "standard_charges": [{"minimum": 11.88, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP B VAC 3AG 10MCG 3 DOS IM", "code_information": [{"code": "90759", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP B VAC INJXN ADMIN/RECVD", "code_information": [{"code": "4149F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP B VAC SERIES PREV RECVD", "code_information": [{"code": "4157F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP C QUANT RNA TSTNG DOCD", "code_information": [{"code": "3220F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP C SCREEN HIGH RISK/OTHER", "code_information": [{"code": "G0472", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP C SCRNG DOCD AS DONE", "code_information": [{"code": "3514F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEP NAFLD SEMIQ EVL 28 LIPID", "code_information": [{"code": "344U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPA VACC PED/ADOL 2 DOSE IM", "code_information": [{"code": "90633", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPA VACC PED/ADOL 3 DOSE", "code_information": [{"code": "90634", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPA VACCINE ADULT IM", "code_information": [{"code": "90632", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPAGAM B IM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1571", "type": "HCPCS"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPAGAM B INTRAVENOUS, INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1573", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPARIN ASSAY", "code_information": [{"code": "85520", "type": "CPT"}], "standard_charges": [{"minimum": 15.05, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPARIN INFUSION PUMP", "code_information": [{"code": "E1520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPARIN IV FLUSH INJ 50U/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1642", "type": "HCPCS"}, {"code": "7000221", "type": "CDM"}, {"code": "64253022235", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN NEUTRALIZATION", "code_information": [{"code": "85525", "type": "CPT"}], "standard_charges": [{"minimum": 13.62, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPARIN SOD 25,000 UNITS/500ML NS", "drug_information": {"unit": 5.0, "type": "EA"}, "code_information": [{"code": "J1644", "type": "HCPCS"}, {"code": "72000437", "type": "CDM"}, {"code": "00641040012", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 90.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN SODIUM 5000 UNITS/ML INJ", "drug_information": {"unit": 5.0, "type": "EA"}, "code_information": [{"code": "J1644", "type": "HCPCS"}, {"code": "7000224", "type": "CDM"}, {"code": "00641040012", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 90.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN-PROTAMINE TOLERANCE", "code_information": [{"code": "85530", "type": "CPT"}], "standard_charges": [{"minimum": 15.05, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATIC FUNCTION", "code_information": [{"code": "80076", "type": "CPT"}, {"code": "1000155", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.4, "maximum": 43.52, "gross_charge": 48.36, "discounted_cash": 54.17, "estimated_discounted_cash": 51.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 38.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 43.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATIC NEW", "code_information": [{"code": "80076", "type": "CPT"}, {"code": "1400019", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.4, "maximum": 43.52, "gross_charge": 48.36, "discounted_cash": 54.17, "estimated_discounted_cash": 51.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 38.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 43.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS A IgM", "code_information": [{"code": "86709", "type": "CPT"}, {"code": "1000106", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.95, "maximum": 59.96, "gross_charge": 66.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 53.3, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 59.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B CORE Ab IgM", "code_information": [{"code": "86704", "type": "CPT"}, {"code": "1000889", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 74.7, "gross_charge": 83.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 66.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 47.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B CORE TOTAL", "code_information": [{"code": "86704", "type": "CPT"}, {"code": "1000298", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 64.2, "gross_charge": 71.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B DNA AMP PROBE", "code_information": [{"code": "87516", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B PROFILE", "code_information": [{"code": "86704", "type": "CPT"}, {"code": "1000279", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 186.3, "gross_charge": 207.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 165.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 186.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 117.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B QUANT DNA", "code_information": [{"code": "87517", "type": "CPT"}, {"code": "1000837", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 49.27, "maximum": 224.1, "gross_charge": 249.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 199.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 224.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 141.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B SURFACE AB QUALITATIVE", "code_information": [{"code": "86706", "type": "CPT"}, {"code": "1000990", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.35, "maximum": 57.21, "gross_charge": 63.57, "discounted_cash": 54.17, "estimated_discounted_cash": 63.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B SURFACE AG QUAN", "code_information": [{"code": "87467", "type": "CPT"}], "standard_charges": [{"minimum": 17.61, "maximum": 17.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B SURFACE ANTIBODY QUANT", "code_information": [{"code": "86706", "type": "CPT"}, {"code": "1000292", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.35, "maximum": 57.21, "gross_charge": 63.57, "discounted_cash": 54.17, "estimated_discounted_cash": 63.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B SURFACE ANTIGEN", "code_information": [{"code": "87340", "type": "CPT"}, {"code": "1000282", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.88, "maximum": 55.02, "gross_charge": 61.14, "discounted_cash": 54.17, "estimated_discounted_cash": 61.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 48.91, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 55.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS Be AB", "code_information": [{"code": "86707", "type": "CPT"}, {"code": "1000888", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.31, "maximum": 57.91, "gross_charge": 64.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 51.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS Be Ag", "code_information": [{"code": "87350", "type": "CPT"}, {"code": "1000890", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 57.69, "gross_charge": 64.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 51.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C RNA DIR PROBE", "code_information": [{"code": "87520", "type": "CPT"}], "standard_charges": [{"minimum": 35.9, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C VIRUS QUANT/ PCR", "code_information": [{"code": "87522", "type": "CPT"}, {"code": "1000820", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 49.27, "maximum": 222.3, "gross_charge": 247.0, "discounted_cash": 54.17, "estimated_discounted_cash": 247.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 197.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 222.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 140.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C W/RIBA", "code_information": [{"code": "86804", "type": "CPT"}, {"code": "1000619", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 17.81, "maximum": 166.5, "gross_charge": 185.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 148.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 166.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 105.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS D QUANTIFICATION", "code_information": [{"code": "87523", "type": "CPT"}], "standard_charges": [{"minimum": 49.27, "maximum": 49.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS DELTA AGENT AG IA", "code_information": [{"code": "87380", "type": "CPT"}], "standard_charges": [{"minimum": 21.11, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS DELTA AGENT ANTBDY", "code_information": [{"code": "86692", "type": "CPT"}], "standard_charges": [{"minimum": 19.73, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA AMP PROBE", "code_information": [{"code": "87526", "type": "CPT"}], "standard_charges": [{"minimum": 45.15, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA DIR PROBE", "code_information": [{"code": "87525", "type": "CPT"}], "standard_charges": [{"minimum": 34.27, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA QUANT", "code_information": [{"code": "87527", "type": "CPT"}], "standard_charges": [{"minimum": 48.02, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS PANEL", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "1000171", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 26.51, "maximum": 181.87, "gross_charge": 202.08, "discounted_cash": 54.17, "estimated_discounted_cash": 204.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 161.66, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 181.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 115.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOBIL SYST IMAGE W/DRUG", "code_information": [{"code": "78227", "type": "CPT"}], "standard_charges": [{"minimum": 518.89, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [{"code": "421", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC", "code_information": [{"code": "420", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "422", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY SYSTEM IMAGING", "code_information": [{"code": "78226", "type": "CPT"}], "standard_charges": [{"minimum": 386.1, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 386.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPB SCREEN HIGH RISK INDIV", "code_information": [{"code": "G0499", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 2 DOSE ADOLESC IM", "code_information": [{"code": "90743", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 2/4 DOSE ADULT IM", "code_information": [{"code": "90739", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 3 DOSE PED/ADOL IM", "code_information": [{"code": "90744", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 4 DOSE IMMUNSUP IM", "code_information": [{"code": "90747", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPB VACCINE 3 DOSE ADULT IM", "code_information": [{"code": "90746", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPC GN TSTNG DOCD B/4TXMNT", "code_information": [{"code": "3266F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPCIDIN-25 ELISA SERUM/PLSM", "code_information": [{"code": "251U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HER-2 POS", "code_information": [{"code": "G9830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO 17 GEN", "code_information": [{"code": "102U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO PANEL", "code_information": [{"code": "129U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO PNL 13", "code_information": [{"code": "131U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA DO 15 GENES", "code_information": [{"code": "101U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA DO MRNA PNL", "code_information": [{"code": "130U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA TRGT MRNA PNL", "code_information": [{"code": "162U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED GYN CA MRNA PNL 12 GEN", "code_information": [{"code": "135U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED OVA CA PNL 24 GENES", "code_information": [{"code": "103U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED OVA CA RLTD DO PNL 17", "code_information": [{"code": "132U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED PAN CA MRNA PNL 18 GEN", "code_information": [{"code": "134U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERED PRST8 CA RLTD DO 11", "code_information": [{"code": "133U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEREDITARY COLON CA DSORDRS", "code_information": [{"code": "81435", "type": "CPT"}], "standard_charges": [{"minimum": 672.64, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 672.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEREDITARY RETINAL DISORDERS", "code_information": [{"code": "81434", "type": "CPT"}], "standard_charges": [{"minimum": 687.6, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 687.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEREDTRY NURONDCRN TUM DSRDR", "code_information": [{"code": "81437", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 504.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 504.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC", "code_information": [{"code": "354", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC", "code_information": [{"code": "353", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC", "code_information": [{"code": "355", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HEROIN METABOLITE", "code_information": [{"code": "80356", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX 1 AG IF", "code_information": [{"code": "87274", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX 2 AG IF", "code_information": [{"code": "87273", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX AB IgG TYPE 1", "code_information": [{"code": "86695", "type": "CPT"}, {"code": "1000568", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "gross_charge": 78.06, "discounted_cash": 54.17, "estimated_discounted_cash": 78.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX AB IgG TYPE 2", "code_information": [{"code": "86696", "type": "CPT"}, {"code": "1000572", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 22.25, "maximum": 103.11, "gross_charge": 114.57, "discounted_cash": 54.17, "estimated_discounted_cash": 114.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 91.65, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX Ab IgG TYPE 1&2", "code_information": [{"code": "86695", "type": "CPT"}, {"code": "1000573", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "gross_charge": 78.06, "discounted_cash": 54.17, "estimated_discounted_cash": 78.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX Ab IgM TYPE 1&2 COMBO", "code_information": [{"code": "86695", "type": "CPT"}, {"code": "1000575", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "gross_charge": 78.06, "discounted_cash": 54.17, "estimated_discounted_cash": 78.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX NES ANTBDY", "code_information": [{"code": "86694", "type": "CPT"}], "standard_charges": [{"minimum": 16.55, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HESPAN (HESTASTARCH) 6%/500ML NS IVPB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000284", "type": "CDM"}, {"code": "00264196510", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HETEROPHILE ANTIBODY ABSRBJ", "code_information": [{"code": "86310", "type": "CPT"}], "standard_charges": [{"minimum": 8.48, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEXA GENE", "code_information": [{"code": "81255", "type": "CPT"}], "standard_charges": [{"minimum": 59.17, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEXAGNAL PHOSPH PLTLT NEUTRL", "code_information": [{"code": "85598", "type": "CPT"}], "standard_charges": [{"minimum": 20.68, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEXAGONAL PHASE PHOSPHOLIPID", "code_information": [{"code": "85732", "type": "CPT"}, {"code": "1000528", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.44, "maximum": 34.47, "gross_charge": 38.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 34.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HF ASSESSMENT TOOL COMPLETED", "code_information": [{"code": "3117F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HFE GENE", "code_information": [{"code": "81256", "type": "CPT"}], "standard_charges": [{"minimum": 75.16, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 75.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HG A1C LEVEL LT 7.0%", "code_information": [{"code": "3044F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HG A1C>EQUAL 7.0%<8.0%", "code_information": [{"code": "3051F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HG A1C>EQUAL 8.0%<EQUAL 9.0%", "code_information": [{"code": "3052F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HGB ELECTROPHORESIS", "code_information": [{"code": "83020", "type": "CPT"}, {"code": "1000170", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.8, "maximum": 68.58, "gross_charge": 76.2, "discounted_cash": 54.17, "estimated_discounted_cash": 87.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 60.96, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB LVL 11-12.9 G/DL", "code_information": [{"code": "3280F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HGB LVL <11 G/DL", "code_information": [{"code": "3281F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HGB LVL >= 13 G/DL", "code_information": [{"code": "3279F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HGB METHEMOGLOBIN QUAL", "code_information": [{"code": "83045", "type": "CPT"}], "standard_charges": [{"minimum": 7.46, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HGB METHEMOGLOBIN QUAN", "code_information": [{"code": "83050", "type": "CPT"}], "standard_charges": [{"minimum": 9.43, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HGB QUANT TRANSCUTANEOUS", "code_information": [{"code": "88738", "type": "CPT"}], "standard_charges": [{"minimum": 5.77, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HGB SULFHEMOGLOBIN QUAN", "code_information": [{"code": "83060", "type": "CPT"}], "standard_charges": [{"minimum": 10.12, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HGH RISK FOR THROMBOEMBOLISM", "code_information": [{"code": "3552F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HH AIDE OR CN AIDE PER VISIT", "code_information": [{"code": "T1021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HH RESPIRATORY THRPY IN EVAL", "code_information": [{"code": "S5180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HH RESPIRATORY THRPY NOS/DAY", "code_information": [{"code": "S5181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHC OCCUP THERAPY EA 15", "code_information": [{"code": "G0160", "type": "HCPCS"}], "standard_charges": [{"minimum": 589.34, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHC OT ASSISTANT EA 15", "code_information": [{"code": "G0158", "type": "HCPCS"}], "standard_charges": [{"minimum": 589.34, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHC PT ASSISTANT EA 15", "code_information": [{"code": "G0157", "type": "HCPCS"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHC PT MAINT EA 15 MIN", "code_information": [{"code": "G0159", "type": "HCPCS"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHC RN E&M PLAN SVS, 15 MIN", "code_information": [{"code": "G0162", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHC SLP EA 15 MIN", "code_information": [{"code": "G0161", "type": "HCPCS"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SERV OF OT,EA 15 MIN", "code_information": [{"code": "G0152", "type": "HCPCS"}], "standard_charges": [{"minimum": 589.34, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SERV OF PT,EA 15 MIN", "code_information": [{"code": "G0151", "type": "HCPCS"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SVS OF AIDE,EA 15 MIN", "code_information": [{"code": "G0156", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SVS OF CSW,EA 15 MIN", "code_information": [{"code": "G0155", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SVS OF S/L PATH,EA 15MN", "code_information": [{"code": "G0153", "type": "HCPCS"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHF10-P PER SQ CM", "code_information": [{"code": "Q4224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHS/HOSPICE OF LPN EA 15 MIN", "code_information": [{"code": "G0300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHS/HOSPICE OF RN EA 15 MIN", "code_information": [{"code": "G0299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA AMP PROBE", "code_information": [{"code": "87532", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA DIR PROBE", "code_information": [{"code": "87531", "type": "CPT"}], "standard_charges": [{"minimum": 66.7, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 66.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA QUANT", "code_information": [{"code": "87533", "type": "CPT"}], "standard_charges": [{"minimum": 48.02, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HI ENRGY ESWT PLANTAR FASCIA", "code_information": [{"code": "28890", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HI INTEN SERV FOR SIP MODEL", "code_information": [{"code": "G2020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIB PRP-OMP VACC 3 DOSE IM", "code_information": [{"code": "90647", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIB PRP-T VACCINE 4 DOSE IM", "code_information": [{"code": "90648", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIB-HEPB VACCINE IM", "code_information": [{"code": "90748", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIB-MENCY VACC 6WK-18M0 IM", "code_information": [{"code": "90644", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIBICLENS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3001426", "type": "CDM"}, {"code": "00116106108", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 23.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HICKORY NUT - RAST", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000626", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGH INTEN BEH COUNS STD 30M", "code_information": [{"code": "G0445", "type": "HCPCS"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIGH RISK PROSTATE CANCER", "code_information": [{"code": "3273F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIGH RISK RECURRENCE PRO CA", "code_information": [{"code": "G8465", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIGH SENSITIVITY C REACTIVE PROTEIN", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "1000613", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.89, "maximum": 72.0, "gross_charge": 80.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGHTOP W/ SUPP/PRONATOR CHI", "code_information": [{"code": "L3206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIGHTOP W/ SUPP/PRONATOR INF", "code_information": [{"code": "L3204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIGHTOP W/ SUPP/PRONATOR JUN", "code_information": [{"code": "L3207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [{"code": "481", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [{"code": "480", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC", "code_information": [{"code": "482", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/DEBRIDEMENT", "code_information": [{"code": "29862", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/SYNOVECTOMY", "code_information": [{"code": "29863", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO ACETABULOPLASTY", "code_information": [{"code": "29915", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FB REMOVAL", "code_information": [{"code": "29861", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FEMOROPLASTY", "code_information": [{"code": "29914", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/LABRAL REPAIR", "code_information": [{"code": "29916", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP ARTHROSCOPY DX", "code_information": [{"code": "29860", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP CORE DECOMPRESSION", "code_information": [{"code": "S2325", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP MIDLINE CATH INSERT KIT", "code_information": [{"code": "S5523", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [{"code": "521", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [{"code": "522", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIP/KNEE EQUIPMENT KIT", "code_information": [{"code": "3001295", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HIPPOTHERAPY PER SESSION", "code_information": [{"code": "S8940", "type": "HCPCS"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIPREX (METHENAMINE HIPP) 1GM TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001784", "type": "CDM"}, {"code": "65862078201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.07, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HIST TYPE DOC ON REPORT", "code_information": [{"code": "G9283", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTAMINES 24HR URINE", "code_information": [{"code": "83088", "type": "CPT"}, {"code": "1000827", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 33.96, "maximum": 147.79, "gross_charge": 164.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 131.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 147.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOCHEMICAL STAINS ADD-ON", "code_information": [{"code": "88314", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 104.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 104.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMA ANTIBODY", "code_information": [{"code": "86698", "type": "CPT"}], "standard_charges": [{"minimum": 15.86, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMOSIS AG SERUM", "code_information": [{"code": "87385", "type": "CPT"}, {"code": "1000643", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.24, "maximum": 63.9, "gross_charge": 71.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMOSIS AG URINE", "code_information": [{"code": "87385", "type": "CPT"}, {"code": "1000315", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.24, "maximum": 63.9, "gross_charge": 71.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMOSIS SKIN TEST", "code_information": [{"code": "86510", "type": "CPT"}], "standard_charges": [{"minimum": 7.79, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTORY AIDS-DEFINING COND", "code_information": [{"code": "3490F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTORY CD4+ CELL COUNT <350", "code_information": [{"code": "3492F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTORY OF MOLE CHANGES", "code_information": [{"code": "1050F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTOTRIPSY MAL HEPATCEL TIS", "code_information": [{"code": "686T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTRELIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1675", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ALPHA-1-PROTEINAS DIEM", "code_information": [{"code": "S9346", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-HEMOPHIL DIEM", "code_information": [{"code": "S9345", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-SPASMOTIC DIEM", "code_information": [{"code": "S9363", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-TNF PER DIEM", "code_information": [{"code": "S9359", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q12H DIEM", "code_information": [{"code": "S9501", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q24H DIEM", "code_information": [{"code": "S9500", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q3H DIEM", "code_information": [{"code": "S9497", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q4H DIEM", "code_information": [{"code": "S9504", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q6H DIEM", "code_information": [{"code": "S9503", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q8H DIEM", "code_information": [{"code": "S9502", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC TOTAL DIEM", "code_information": [{"code": "S9494", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT BLOOD PRODUCTS DIEM", "code_information": [{"code": "S9538", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CATH CARE NOC", "code_information": [{"code": "S5497", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CATH REPAIR KIT", "code_information": [{"code": "S5518", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CHELATION DIEM", "code_information": [{"code": "S9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CHEMO PER DIEM", "code_information": [{"code": "S9329", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT COMPLEX CATH CARE", "code_information": [{"code": "S5501", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT ANTICOAG DIEM", "code_information": [{"code": "S9336", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT ANTIEMETIC DIEM", "code_information": [{"code": "S9351", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT CHEM DIEM", "code_information": [{"code": "S9330", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT INSULIN DIEM", "code_information": [{"code": "S9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT PAIN PER DIEM", "code_information": [{"code": "S9326", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CORTICOSTEROID/DIEM", "code_information": [{"code": "S9490", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT DECLOTTING KIT", "code_information": [{"code": "S5517", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT DEVICE REPAIR", "code_information": [{"code": "S5036", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT DIURETIC INFUS DIEM", "code_information": [{"code": "S9361", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL BOLUS NURS", "code_information": [{"code": "S9343", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL GRAV DIEM", "code_information": [{"code": "S9341", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL PER DIEM", "code_information": [{"code": "S9340", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL PUMP DIEM", "code_information": [{"code": "S9342", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENZYME REPLACE DIEM", "code_information": [{"code": "S9357", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HIGH RISK/ESCORT", "code_information": [{"code": "S9381", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 1 LITER DIEM", "code_information": [{"code": "S9374", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 2 LITER DIEM", "code_information": [{"code": "S9375", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 3 LITER DIEM", "code_information": [{"code": "S9376", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA OVER 3L DIEM", "code_information": [{"code": "S9377", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA TOTAL DIEM", "code_information": [{"code": "S9373", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT IMMUNOTHERAPY DIEM", "code_information": [{"code": "S9338", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT INJ INTERFERON DIEM", "code_information": [{"code": "S9559", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT INT PAIN PER DIEM", "code_information": [{"code": "S9327", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT INTERIM CATH CARE", "code_information": [{"code": "S5502", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT INTERMIT CHEMO DIEM", "code_information": [{"code": "S9331", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT LONGTERM INFUSION DIEM", "code_information": [{"code": "S9347", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT MIDLINE CATH INSERT KIT", "code_information": [{"code": "S5521", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT NOC PER DIEM", "code_information": [{"code": "S9379", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PAIN IMP PUMP DIEM", "code_information": [{"code": "S9328", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PAIN MGMT PER DIEM", "code_information": [{"code": "S9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PERITON DIALYSIS DIEM", "code_information": [{"code": "S9339", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PICC INSERT KIT", "code_information": [{"code": "S5520", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PICC INSERT NO SUPP", "code_information": [{"code": "S5522", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ROUTINE DEVICE MAINT", "code_information": [{"code": "S5035", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT SIMPLE CATH CARE", "code_information": [{"code": "S5498", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT SYMPATHOMIM DIEM", "code_information": [{"code": "S9348", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TOCOLYSIS DIEM", "code_information": [{"code": "S9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN 1 LITER DIEM", "code_information": [{"code": "S9365", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN 2 LITER DIEM", "code_information": [{"code": "S9366", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN 3 LITER DIEM", "code_information": [{"code": "S9367", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN OVER 3L DIEM", "code_information": [{"code": "S9368", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN TOTAL DIEM", "code_information": [{"code": "S9364", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV -2 ANTIBODIES EIA", "code_information": [{"code": "86702", "type": "CPT"}, {"code": "1000782", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.55, "maximum": 72.0, "gross_charge": 80.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV 1/0/2 ANTIGEN ANTIBODY FOURTH GEN", "code_information": [{"code": "87389", "type": "CPT"}, {"code": "1000172", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 27.69, "maximum": 120.52, "gross_charge": 133.92, "discounted_cash": 54.17, "estimated_discounted_cash": 135.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 107.13, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 120.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 76.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV AG W/HIV1&2 ANTB W/OPTIC", "code_information": [{"code": "87806", "type": "CPT"}], "standard_charges": [{"minimum": 37.69, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 37.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV COMBINATION ASSAY", "code_information": [{"code": "G0475", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP COUNSEL, CLIN STAFF", "code_information": [{"code": "G0013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP COUNSEL, MD 15-30M", "code_information": [{"code": "G0011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP, FDA APPROVED, NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0799", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP, FTC/TAF 200/25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0751", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP, FTC/TDF 200/300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0750", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP, INJ, CABOTEGRAVIR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0739", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV RNA PLAN CARE DOCD", "code_information": [{"code": "575F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV RNA VRL LD <LMTS QUANTIF", "code_information": [{"code": "3502F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV RNA VRL LDNOT<LMTS QUNTF", "code_information": [{"code": "3503F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV TSTNG ASKED/DOCD/REVWD", "code_information": [{"code": "3292F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV UNSURE BABY OF HIV+MOMS", "code_information": [{"code": "3491F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC", "code_information": [{"code": "969", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [{"code": "970", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITH CC", "code_information": [{"code": "975", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [{"code": "974", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC", "code_information": [{"code": "976", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [{"code": "977", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HIV-1 AG IA", "code_information": [{"code": "87390", "type": "CPT"}], "standard_charges": [{"minimum": 27.67, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-1 ANTIBODY TESTING OF OR", "code_information": [{"code": "S3645", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-1 DNA DIR PROBE", "code_information": [{"code": "87534", "type": "CPT"}], "standard_charges": [{"minimum": 25.21, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-1 PROBE&REVERSE TRNSCRPJ", "code_information": [{"code": "87535", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-1 QUANT&REVRSE TRNSCRPJ", "code_information": [{"code": "87536", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 97.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 97.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-1/HIV-2 1 RESULT ANTBDY", "code_information": [{"code": "86703", "type": "CPT"}], "standard_charges": [{"minimum": 15.77, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-1ANTIBODY", "code_information": [{"code": "86701", "type": "CPT"}], "standard_charges": [{"minimum": 10.22, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-2 AG IA", "code_information": [{"code": "87391", "type": "CPT"}], "standard_charges": [{"minimum": 25.19, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-2 DNA DIR PROBE", "code_information": [{"code": "87537", "type": "CPT"}], "standard_charges": [{"minimum": 25.21, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-2 PROBE&REVRSE TRNSCRIPJ", "code_information": [{"code": "87538", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV-2 QUANT&REVRSE TRNSCRIPJ", "code_information": [{"code": "87539", "type": "CPT"}], "standard_charges": [{"minimum": 67.41, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIZENTRA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1559", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HL NEO GSAP 5-50 RNA ALYS", "code_information": [{"code": "81451", "type": "CPT"}], "standard_charges": [{"minimum": 888.65, "maximum": 888.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 888.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HL NEO GSAP 5-50DNA/DNA&RNA", "code_information": [{"code": "81450", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 873.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 873.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA -B27", "code_information": [{"code": "81374", "type": "CPT"}, {"code": "1000551", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 85.48, "maximum": 269.43, "gross_charge": 299.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 85.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 239.49, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 269.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 170.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I HIGH DEFIN QUAL", "code_information": [{"code": "86832", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 372.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 372.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I PHENOTYPE QUAL", "code_information": [{"code": "86830", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 109.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 109.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I SEMIQUANT PANEL", "code_information": [{"code": "86834", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 411.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 411.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I&II ANTIBODY QUAL", "code_information": [{"code": "86828", "type": "CPT"}], "standard_charges": [{"minimum": 73.82, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 73.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I/II ANTIBODY QUAL", "code_information": [{"code": "86829", "type": "CPT"}], "standard_charges": [{"minimum": 73.82, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 73.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II HIGH DEFIN QUAL", "code_information": [{"code": "86833", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 374.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 374.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II PHENOTYPE QUAL", "code_information": [{"code": "86831", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 94.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 94.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II SEMIQUANT PANEL", "code_information": [{"code": "86835", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 371.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 371.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPE VERIFY LR", "code_information": [{"code": "81371", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 465.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 465.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPING HR", "code_information": [{"code": "81378", "type": "CPT"}], "standard_charges": [{"minimum": 397.41, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 397.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPING LR", "code_information": [{"code": "81370", "type": "CPT"}], "standard_charges": [{"minimum": 462.44, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 462.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 ALLELE HR", "code_information": [{"code": "81381", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 195.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 195.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 LOCUS HR", "code_information": [{"code": "81380", "type": "CPT"}], "standard_charges": [{"minimum": 203.84, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 203.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 LOCUS LR", "code_information": [{"code": "81373", "type": "CPT"}], "standard_charges": [{"minimum": 146.54, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 146.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING COMPLETE HR", "code_information": [{"code": "81379", "type": "CPT"}], "standard_charges": [{"minimum": 385.69, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 385.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING COMPLETE LR", "code_information": [{"code": "81372", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 464.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 464.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA II TYPE 1 AG EQUIV LR", "code_information": [{"code": "81377", "type": "CPT"}], "standard_charges": [{"minimum": 108.95, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 108.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING 1 ALLELE HR", "code_information": [{"code": "81383", "type": "CPT"}], "standard_charges": [{"minimum": 125.5, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING 1 LOC HR", "code_information": [{"code": "81382", "type": "CPT"}], "standard_charges": [{"minimum": 142.23, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 142.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING 1 LOCUS LR", "code_information": [{"code": "81376", "type": "CPT"}], "standard_charges": [{"minimum": 140.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING AG EQUIV LR", "code_information": [{"code": "81375", "type": "CPT"}], "standard_charges": [{"minimum": 253.85, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 253.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA TYPING A B OR C", "code_information": [{"code": "86812", "type": "CPT"}], "standard_charges": [{"minimum": 29.68, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA TYPING A B OR C", "code_information": [{"code": "86813", "type": "CPT"}], "standard_charges": [{"minimum": 66.7, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 66.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA TYPING DR/DQ", "code_information": [{"code": "86816", "type": "CPT"}], "standard_charges": [{"minimum": 34.7, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA TYPING DR/DQ", "code_information": [{"code": "86817", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 122.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 122.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA X-MATCH NONCYTOTOXC ADDL", "code_information": [{"code": "86826", "type": "CPT"}], "standard_charges": [{"minimum": 42.01, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLA X-MATH NON-CYTOTOXIC", "code_information": [{"code": "86825", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 125.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV ASSMT/REASSESSMENT", "code_information": [{"code": "96156", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ FAM 1ST 30", "code_information": [{"code": "96167", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ FAM EA ADDL", "code_information": [{"code": "96168", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ FAM W/O PT EA", "code_information": [{"code": "96171", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ FAM WO PT 1ST", "code_information": [{"code": "96170", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ GRP 1ST 30", "code_information": [{"code": "96164", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ GRP EA ADDL", "code_information": [{"code": "96165", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ INDIV 1ST 30", "code_information": [{"code": "96158", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH BHV IVNTJ INDIV EA ADDL", "code_information": [{"code": "96159", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING GROUP", "code_information": [{"code": "593T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING INDIV 1ST", "code_information": [{"code": "591T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING INDIV F-UP", "code_information": [{"code": "592T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HM GEST DM PER DIEM", "code_information": [{"code": "S9214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HM POSTPAR HYPER PER DIEM", "code_information": [{"code": "S9212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HM PREECLAMP PER DIEM", "code_information": [{"code": "S9213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HMATRIX", "code_information": [{"code": "Q4134", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM 150-199MG/ML IODINE,1ML", "code_information": [{"code": "Q9959", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM 200-249MG/ML IODINE,1ML", "code_information": [{"code": "Q9960", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM 250-299MG/ML IODINE,1ML", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM 300-349MG/ML IODINE,1ML", "code_information": [{"code": "Q9962", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM <=149 MG/ML IODINE, 1ML", "code_information": [{"code": "Q9958", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM>= 400MG/ML IODINE, 1ML", "code_information": [{"code": "Q9964", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOMAKER SERVICE NOS PER 15M", "code_information": [{"code": "S5130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME ENVIRONMENT ASSESSMENT", "code_information": [{"code": "T1028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME EPISODIC CASE 30 DAYS", "code_information": [{"code": "S0272", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME H PHYSIO DATA COLLEC TR", "code_information": [{"code": "G0322", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH AIDE OR CERTIFIE", "code_information": [{"code": "S9122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99374", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99375", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "G0181", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HOSPICE CASE 30 DAYS", "code_information": [{"code": "S0271", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME IVIG, SERVICES/SUPPLIES", "code_information": [{"code": "Q2052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME MGMT GEST HYPERTENSION", "code_information": [{"code": "S9211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME MGMT PPROM", "code_information": [{"code": "S9209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME MGMT PRETERM LABOR", "code_information": [{"code": "S9208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME MODIFICATIONS PER SERV", "code_information": [{"code": "S5165", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME NFS VISIT <2 HRS", "code_information": [{"code": "99601", "type": "CPT"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME NFS VISIT EACH ADDL HR", "code_information": [{"code": "99602", "type": "CPT"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME PHOTOTHERAPY VISIT", "code_information": [{"code": "S9098", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 2 PORTA", "code_information": [{"code": "G0398", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 3 PORTA", "code_information": [{"code": "G0399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 4 PORTA", "code_information": [{"code": "G0400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME STD CASE RATE 30 DAYS", "code_information": [{"code": "S0270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME SUPPLY INJECT NALOXON", "code_information": [{"code": "G2216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME SUPPLY NASAL NALOXONE", "code_information": [{"code": "G2215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME UTERINE MONITOR WITH OR", "code_information": [{"code": "S9001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VENT MGMT SUPERVISION", "code_information": [{"code": "94005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT CATH MAINTAIN", "code_information": [{"code": "99507", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT DAY LIFE ACTIVITY", "code_information": [{"code": "99509", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT FECAL/ENEMA MGMT", "code_information": [{"code": "99511", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT FOR HEMODIALYSIS", "code_information": [{"code": "99512", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT IM INJECTION", "code_information": [{"code": "99506", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT MECH VENTILATOR", "code_information": [{"code": "99504", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT NB CARE", "code_information": [{"code": "99502", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT POSTNATAL", "code_information": [{"code": "99501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT PRENATAL", "code_information": [{"code": "99500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT RESP THERAPY", "code_information": [{"code": "99503", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT RN, LPN BY RHC/FQ", "code_information": [{"code": "G0490", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT SING/M/FAM COUNS", "code_information": [{"code": "99510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT STOMA CARE", "code_information": [{"code": "99505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME VISIT WOUND CARE", "code_information": [{"code": "S9097", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST HIGH MDM 60", "code_information": [{"code": "99350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST LOW MDM 30", "code_information": [{"code": "99348", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST MOD MDM 40", "code_information": [{"code": "99349", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST SF MDM 20", "code_information": [{"code": "99347", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST NEW HIGH MDM 75", "code_information": [{"code": "99345", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST NEW LOW MDM 30", "code_information": [{"code": "99342", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST NEW MOD MDM 60", "code_information": [{"code": "99344", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST NEW SF MDM 15", "code_information": [{"code": "99341", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOMECARE TRAIN PT 15 MIN", "code_information": [{"code": "S5108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOMECARE TRAIN PT SESSION", "code_information": [{"code": "S5109", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOMEDELIVERED PREPARED MEAL", "code_information": [{"code": "S5170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOMEMAKER SERVICE NOS /DIEM", "code_information": [{"code": "S5131", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOMOCYSTINE", "code_information": [{"code": "83090", "type": "CPT"}, {"code": "1000326", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.61, "maximum": 117.0, "gross_charge": 130.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 74.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOPD MNTL HLT, 15-29 MIN", "code_information": [{"code": "C7900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOPD MNTL HLT, 30-60 MIN", "code_information": [{"code": "C7901", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOPD MNTL HLT, EA ADDL", "code_information": [{"code": "C7902", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOPD MNTL HLT, GRP", "code_information": [{"code": "C7903", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP GRADE ELEC BREAST PUMP", "code_information": [{"code": "E0604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS DSCHRG MGMT >30", "code_information": [{"code": "99239", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS SAME DATE HI 85", "code_information": [{"code": "99236", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS SAME DATE MOD 70", "code_information": [{"code": "99235", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS SM DT SF/LOW 45", "code_information": [{"code": "99234", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP MANAGE CONT DRUG ADMIN", "code_information": [{"code": "1996", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP NEW DX CVA CONSID EVST", "code_information": [{"code": "G9767", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP RECD BY PT DUR MSMT PER", "code_information": [{"code": "G9692", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP RECD BY PT DUR MSMT PER", "code_information": [{"code": "G9723", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP SRV TO PT DUR MSMT PER", "code_information": [{"code": "G9740", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP SRV USED PT IN MSMT PER", "code_information": [{"code": "G9694", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP SRV USED PT IN MSMT PER", "code_information": [{"code": "G9709", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSP+PALL CARE SPEC CODE 17", "code_information": [{"code": "M1365", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPC SERV DUR MEAS PD", "code_information": [{"code": "M1159", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPC SERV DUR MEAS PD", "code_information": [{"code": "M1303", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE ANYTIME MSMT PER", "code_information": [{"code": "G9687", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE ANYTIME MSMT PER", "code_information": [{"code": "G9720", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "99377", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "99378", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "G0182", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE, IN THE HOME, P", "code_information": [{"code": "S9126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE CONTINUOUS HOME CARE", "code_information": [{"code": "T2043", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE EVALUATION PREELECTI", "code_information": [{"code": "G0337", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE GENERAL CARE", "code_information": [{"code": "T2045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE HOME CARE IN HOSPICE", "code_information": [{"code": "Q5010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN HOSPICE FACILITY", "code_information": [{"code": "Q5006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN INPATIENT PSYCH", "code_information": [{"code": "Q5008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN LT/NON-SKILLED NF", "code_information": [{"code": "Q5003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN LTCH", "code_information": [{"code": "Q5007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN SNF", "code_information": [{"code": "Q5004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE LONG TERM CARE, R&B", "code_information": [{"code": "T2046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE OR HOME HLTH IN HOME", "code_information": [{"code": "Q5001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE REFER VISIT NONMD", "code_information": [{"code": "S0255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE RESPITE CARE", "code_information": [{"code": "T2044", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE ROUTINE HOME CARE", "code_information": [{"code": "T2042", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE, INPATIENT HOSPITAL", "code_information": [{"code": "Q5005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE/HOME HLTH IN ASST LV", "code_information": [{"code": "Q5002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE/HOME HLTH, PLACE NOS", "code_information": [{"code": "Q5009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPITAL ADMIT (LOW COMP)ER PHYS", "code_information": [{"code": "99221", "type": "CPT"}, {"code": "11200001", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 146.39, "maximum": 231.14, "gross_charge": 256.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 192.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 205.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 231.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 146.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPITAL BED INSTITUTIONAL T", "code_information": [{"code": "E0270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPITAL/ASC CALL", "code_information": [{"code": "D9420", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPITALIST VISIT", "code_information": [{"code": "S0310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPITALISTS SS", "code_information": [{"code": "G4009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOT OR COLD PACKS THERAPY", "code_information": [{"code": "97010", "type": "CPT"}], "standard_charges": [{"minimum": 5.66, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOT/COLD BOTLE/CAP/COL/WRAP", "code_information": [{"code": "A9273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HP LASERJET TONER Q2613X", "code_information": [{"code": "80000910", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 7.32, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HPA-1 GENOTYPING", "code_information": [{"code": "81105", "type": "CPT"}], "standard_charges": [{"minimum": 140.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPA-15 GENOTYPING", "code_information": [{"code": "81112", "type": "CPT"}], "standard_charges": [{"minimum": 140.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPA-2 GENOTYPING", "code_information": [{"code": "81106", "type": "CPT"}], "standard_charges": [{"minimum": 140.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPA-3 GENOTYPING", "code_information": [{"code": "81107", "type": "CPT"}], "standard_charges": [{"minimum": 140.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPA-4 GENOTYPING", "code_information": [{"code": "81108", "type": "CPT"}], "standard_charges": [{"minimum": 140.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPA-5 GENOTYPING", "code_information": [{"code": "81109", "type": "CPT"}], "standard_charges": [{"minimum": 140.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPA-6 GENOTYPING", "code_information": [{"code": "81110", "type": "CPT"}], "standard_charges": [{"minimum": 140.55, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPA-9 GENOTYPING", "code_information": [{"code": "81111", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 140.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPV COMBO ASSAY CA SCREEN", "code_information": [{"code": "G0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.73, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPV HI RISK TYPES MALE URINE", "code_information": [{"code": "96U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPV HIGH-RISK TYPES", "code_information": [{"code": "87624", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPV LOW-RISK TYPES", "code_information": [{"code": "87623", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPV OROP SWAB 14 HI-RISK TYP", "code_information": [{"code": "429U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPV TYPES 16 & 18 ONLY", "code_information": [{"code": "87625", "type": "CPT"}], "standard_charges": [{"minimum": 46.63, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPYLORI DETCJ ABX RSTNC DNA", "code_information": [{"code": "8U", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HRDTRY BRST CA-RLATD DSORDRS", "code_information": [{"code": "81432", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 780.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 780.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HRDTRY CARDMYPY GENE PANEL", "code_information": [{"code": "81439", "type": "CPT"}], "standard_charges": [{"minimum": 672.64, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 672.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HRDTRY PERPH NEURPHY PANEL", "code_information": [{"code": "81448", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 672.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 672.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HSPC DUR MEAS PD", "code_information": [{"code": "M1167", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HSPC PT PRV TIME MEAM PER", "code_information": [{"code": "M1067", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HSPC SVC ANY TIME IN MEAS PD", "code_information": [{"code": "M1191", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HSV 1&2 IgM INDIVIDUAL", "code_information": [{"code": "86695", "type": "CPT"}, {"code": "1000790", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "gross_charge": 78.06, "discounted_cash": 54.17, "estimated_discounted_cash": 78.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.44, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HSV DNA AMP PROBE", "code_information": [{"code": "87529", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HSV DNA DIR PROBE", "code_information": [{"code": "87528", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HSV DNA QUANT", "code_information": [{"code": "87530", "type": "CPT"}], "standard_charges": [{"minimum": 49.27, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT CARE PLAN DOC", "code_information": [{"code": "4050F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT HEM HORM INJ DIEM", "code_information": [{"code": "S9537", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT HEMODIALYSIS DIEM", "code_information": [{"code": "S9335", "type": "HCPCS"}], "standard_charges": [{"minimum": 2442.42, "maximum": 2442.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2442.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT INJ ANTICOAG DIEM", "code_information": [{"code": "S9372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT INJ ANTIEMETIC DIEM", "code_information": [{"code": "S9370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT INJ GROWTH HORM DIEM", "code_information": [{"code": "S9558", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT INJ HORMONE DIEM", "code_information": [{"code": "S9560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT INJ IMMUNO DIEM", "code_information": [{"code": "S9563", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT INJ NOC PER DIEM", "code_information": [{"code": "S9542", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT INJ PALIVIZUMAB/AB DIEM", "code_information": [{"code": "S9562", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT IRRIGATION DIEM", "code_information": [{"code": "S9590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT MUSC IMAGE PLANAR MULT", "code_information": [{"code": "78454", "type": "CPT"}], "standard_charges": [{"minimum": 517.09, "maximum": 3077.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 517.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3077.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE PLANAR SING", "code_information": [{"code": "78453", "type": "CPT"}], "standard_charges": [{"minimum": 352.18, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 352.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE SPECT MULT", "code_information": [{"code": "78452", "type": "CPT"}], "standard_charges": [{"minimum": 565.45, "maximum": 3077.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 565.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3077.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE SPECT SING", "code_information": [{"code": "78451", "type": "CPT"}], "standard_charges": [{"minimum": 406.88, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 406.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HT PHARM PER HOUR", "code_information": [{"code": "S9810", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.01, "maximum": 411.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 411.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HTLV-I ANTIBODY", "code_information": [{"code": "86687", "type": "CPT"}], "standard_charges": [{"minimum": 10.45, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HTLV-II ANTIBODY", "code_information": [{"code": "86688", "type": "CPT"}], "standard_charges": [{"minimum": 16.1, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HTLV/HIV CONFIRMJ ANTIBODY", "code_information": [{"code": "86689", "type": "CPT"}], "standard_charges": [{"minimum": 22.25, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HTR2A HTR2C GENES", "code_information": [{"code": "33U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HTT GENE CHARAC ALLELES", "code_information": [{"code": "81274", "type": "CPT"}], "standard_charges": [{"minimum": 316.05, "maximum": 316.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HTT GENE DETC ABNOR ALLELES", "code_information": [{"code": "81271", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HUMAN EPIDIDYMIS PROTEIN 4", "code_information": [{"code": "86305", "type": "CPT"}], "standard_charges": [{"minimum": 23.93, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HUMAN IG IM", "code_information": [{"code": "90281", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HUMAN IG IV", "code_information": [{"code": "90283", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HUMAN IG SC", "code_information": [{"code": "90284", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HUMATE-P, INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7187", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HUMIDIFIER FOR USE W/ REGULA", "code_information": [{"code": "E0555", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HX DX FAM/PURE HYPERCHOLES", "code_information": [{"code": "G9782", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYALGAN SUPARTZ VISCO-3 DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7321", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYALOMATRIX", "code_information": [{"code": "Q4117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYALURONIDASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3470", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYALURONIDASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3473", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYCET (HYDROCOD/APAP) ELIX 2.5/108/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000992", "type": "CDM"}, {"code": "71930002743", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDRATION STATUS ASSESS", "code_information": [{"code": "2018F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDREA (HYDROXYUREA) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000271", "type": "CDM"}, {"code": "00555088202", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROCHLOROTHIAZIDE TAB 12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000630", "type": "CDM"}, {"code": "50268040415", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROCHLOROTHIAZIDE TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000230", "type": "CDM"}, {"code": "60687059301", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROCODONE/ACETAMINOPHEN CAP : 5-500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000232", "type": "CDM"}, {"code": "00406035762", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROCOLLD DRG > 48 IN W/BDR", "code_information": [{"code": "A6239", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDROCORTISONE 1% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000379", "type": "CDM"}, {"code": "51672206902", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROCORTISONE 2.5% OINT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000235", "type": "CDM"}, {"code": "00168008031", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROCORTISONE 2.50% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000234", "type": "CDM"}, {"code": "51672300302", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROCORTISONE ACETATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDROCORTISONE SODIUM PH INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDROCORTISONE TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000418", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROGEN PEROXIDE 3% SOLN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000272", "type": "CDM"}, {"code": "87701040242", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYDROMORPHONE 250 MG", "code_information": [{"code": "S0092", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDROXYUREA 500 MG", "code_information": [{"code": "S0176", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE PAMOATE 25MG", "code_information": [{"code": "Q0177", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYLANDS LEG CRAMPS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004334", "type": "CDM"}, {"code": "54973295601", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYMENOTOMY", "code_information": [{"code": "56442", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYMOVIS INJECTION 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7322", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYOID MYOTOMY & SUSPENSION", "code_information": [{"code": "21685", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE SULFATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1980", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE SULFATE SL TABLET 0.125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001109", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYPER GEL WOUND DRSG", "code_information": [{"code": "3000206", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYPERBARIC O2 CHAMBER DISPS", "code_information": [{"code": "A4575", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPERBARIC OXYGEN THERAPY", "code_information": [{"code": "99183", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITH MCC", "code_information": [{"code": "304", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITHOUT MCC", "code_information": [{"code": "305", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 5095.16, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77600", "type": "CPT"}], "standard_charges": [{"minimum": 815.91, "maximum": 815.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 815.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77605", "type": "CPT"}], "standard_charges": [{"minimum": 1602.91, "maximum": 1602.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77610", "type": "CPT"}], "standard_charges": [{"minimum": 1113.78, "maximum": 1113.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1113.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77615", "type": "CPT"}], "standard_charges": [{"minimum": 1733.47, "maximum": 1733.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1733.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77620", "type": "CPT"}], "standard_charges": [{"minimum": 1050.27, "maximum": 1050.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1050.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPNOTHERAPY", "code_information": [{"code": "90880", "type": "CPT"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPOTHERMIA ILL NEONATE", "code_information": [{"code": "99184", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPOXIA RESPONSE CURVE", "code_information": [{"code": "94450", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPRPHENYLALNINMIA MNTR QUAN", "code_information": [{"code": "382U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYQVIA 100MG IMMUNEGLOBULIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1575", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/BLADDER REPAIR", "code_information": [{"code": "51925", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58275", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY ABLATION", "code_information": [{"code": "58563", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY BIOPSY", "code_information": [{"code": "58558", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY DX SEP PROC", "code_information": [{"code": "58555", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY LYSIS", "code_information": [{"code": "58559", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE FB", "code_information": [{"code": "58562", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE MYOMA", "code_information": [{"code": "58561", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY RESECT SEPTUM", "code_information": [{"code": "58560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY STERILIZATION", "code_information": [{"code": "58565", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYTRIN (TERAZOSIN) 2MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004306", "type": "CDM"}, {"code": "69452033120", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.56, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYTRIN (TERAZOSIN) CAP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000264", "type": "CDM"}, {"code": "23155073501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYTRIN (TERAZOSIN) CAP 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000503", "type": "CDM"}, {"code": "59746038506", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYZAAR (LOSARTAN POT/HCTZ) TAB 100/12.5", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000972", "type": "CDM"}, {"code": "68180021609", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HYZAAR (LOSARTAN POT/HCTZ) TAB 100/25", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000210", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "HZV VACC RECOMBINANT IM", "code_information": [{"code": "90750", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HZV VACCINE LIVE SUBQ", "code_information": [{"code": "90736", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Harvest of skin for skin cell suspension autograft; each additional 25 sq cm or part thereof (List separately in addition to code for primary procedure)", "code_information": [{"code": "15012", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Harvest of skin for skin cell suspension autograft; first 25 sq cm or less", "code_information": [{"code": "15011", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Hematology (venous thromboembolism [VTE]), genome-wide single-nucleotide polymorphism variants, including F2 and F5 gene analysis, and Leiden variant, by microarray analysis, saliva, report as risk score for VTE", "code_information": [{"code": "529U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Hepatology (nonalcoholic steatohepatitis [NASH]), miR-34a-5p, alpha 2-macroglobulin, YKL40, HbA1c, serum and whole blood, algorithm reported as a single score for NASH activity and fibrosis", "code_information": [{"code": "468U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Hereditary pan-cancer (eg, hereditary sarcomas, hereditary endocrine tumors, hereditary neuroendocrine tumors, hereditary cutaneous melanoma), genomic sequence analysis panel of 88 genes with 20 duplications/deletions using next-generation sequencing (NGS", "code_information": [{"code": "474U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Hereditary prostate cancer-related disorders, genomic sequence analysis panel using next-generation sequencing (NGS), Sanger sequencing, multiplex ligation-dependent probe amplification (MLPA), and array comparative genomic hybridization (CGH), evaluation", "code_information": [{"code": "475U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Herpes simplex virus (HSV) types 1 and 2 and Varicella zoster virus (VZV), amplified probe technique, each pathogen reported as detected or not detected", "code_information": [{"code": "527U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "High-resolution gastric electrophysiology mapping with simultaneous patient-symptom profiling, with interpretation and report", "code_information": [{"code": "868T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf", "code_information": [{"code": "L1653", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Historical trauma (HT) mental health and clinical care for indigenous persons", "code_information": [{"code": "H0053", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance", "code_information": [{"code": "888T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Home lancing/test cartridges", "code_information": [{"code": "A4271", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Home vent dual fnct incl all", "code_information": [{"code": "E0468", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Human papillomavirus (HPV), E6/E7 markers for high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), cervical cells, branched-chain capture hybridization, reported as negative or positive for high risk for HPV", "code_information": [{"code": "502U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I & D ABCESS COMPLEX (TECH)", "code_information": [{"code": "10061", "type": "CPT"}, {"code": "11000053", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 521.82, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D ABCESS SIMPLE TECH)", "code_information": [{"code": "10060", "type": "CPT"}, {"code": "11000055", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 521.82, "gross_charge": 506.85, "discounted_cash": 54.17, "estimated_discounted_cash": 506.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D ABSCESS FINGER SIMPLE (TECH", "code_information": [{"code": "26010", "type": "CPT"}, {"code": "11000057", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 521.82, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D HEMATOMA SIMPLE (TECH)", "code_information": [{"code": "10140", "type": "CPT"}, {"code": "11000059", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 376.01, "maximum": 3504.0, "gross_charge": 659.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 494.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 527.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 593.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 376.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D HEMATOMA SUBUNG (TECH)", "code_information": [{"code": "11740", "type": "CPT"}, {"code": "11000061", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D OF VULVA/PERINEUM", "code_information": [{"code": "56405", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I & D PILONIDAL CYST COMPLEX (TECH)", "code_information": [{"code": "10081", "type": "CPT"}, {"code": "11000063", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1240.74, "maximum": 3504.0, "gross_charge": 2176.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1632.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1741.39, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1959.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1240.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D PIONIDAL CYST SIMPLE (TECH)", "code_information": [{"code": "10080", "type": "CPT"}, {"code": "11000065", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 521.82, "maximum": 1546.69, "gross_charge": 1718.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1288.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1374.84, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1546.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 979.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D VAG HEMATOMA NON-OB", "code_information": [{"code": "57023", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I & D VAGINAL HEMATOMA PP", "code_information": [{"code": "57022", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D ABSC INTRAORAL SOFT TISS", "code_information": [{"code": "D7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS EXTRAORAL", "code_information": [{"code": "D7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS P-SPINE L/S/LS", "code_information": [{"code": "22015", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D COMPLEX PO WOUND INFCTJ", "code_information": [{"code": "10180", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D P-SPINE C/T/CERV-THOR", "code_information": [{"code": "22010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D UPR A/E BURSA", "code_information": [{"code": "23931", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D UPR A/E DP ABSC/HMTMA", "code_information": [{"code": "23930", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I-VITE (OCUVITE) TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000262", "type": "CDM"}, {"code": "24208038762", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "I125 IOTHALAMATE, DX", "code_information": [{"code": "A9554", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I125 SERUM ALBUMIN, DX", "code_information": [{"code": "A9532", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 IODIDE CAP, RX", "code_information": [{"code": "A9517", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 IODIDE SOL, DX", "code_information": [{"code": "A9529", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 IODIDE SOL, RX", "code_information": [{"code": "A9530", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 IODOBENGUATE, DX", "code_information": [{"code": "A9508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 MAX 100UCI", "code_information": [{"code": "A9531", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 SERUM ALBUMIN, DX", "code_information": [{"code": "A9524", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IA INFECTIOUS AGENT ANTIBODY", "code_information": [{"code": "86318", "type": "CPT"}], "standard_charges": [{"minimum": 20.8, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IA NFCT AB SARSCOV2 COVID19", "code_information": [{"code": "86328", "type": "CPT"}], "standard_charges": [{"minimum": 45.23, "maximum": 45.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IAAD BLK AC WV BSNSR SARSCV2", "code_information": [{"code": "408U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADI 16S&18S RRNA GENES", "code_information": [{"code": "112U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADNA BARTONELLA DDPCR", "code_information": [{"code": "301U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADNA BRTNLA DDPCR FLWG LIQ", "code_information": [{"code": "302U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADNA CNS PTHGN NEXT GEN SEQ", "code_information": [{"code": "323U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN 20BCT&FNG ORG", "code_information": [{"code": "321U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN SEMIQ DNA16&1", "code_information": [{"code": "371U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADNA VAG PTHGN PANEL 27 ORG", "code_information": [{"code": "330U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 12-25", "code_information": [{"code": "87507", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 479.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 479.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 6-11", "code_information": [{"code": "87506", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 302.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 302.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IBANDRONATE SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1740", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IBMFS SEQ ALYS PNL 30 GENES", "code_information": [{"code": "81441", "type": "CPT"}], "standard_charges": [{"minimum": 2864.82, "maximum": 2864.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2864.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1741", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN LEVEL", "code_information": [{"code": "80329", "type": "CPT"}, {"code": "1000373", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 107.81, "gross_charge": 119.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 95.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 107.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUTILIDE FUMARATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1742", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IC INF PBW 2501-5000 G SUBSQ", "code_information": [{"code": "99480", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IC LBW INF 1500-2500 G SUBSQ", "code_information": [{"code": "99479", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IC LBW INF < 1500 GM SUBSQ", "code_information": [{"code": "99478", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICAR CATH ABLTJ DSCRT ARRHYT", "code_information": [{"code": "93655", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICAR-C (IRON 100/VIT. C TAB)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001052", "type": "CDM"}, {"code": "60258009901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ICATIBANT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1744", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICD COUNSELING PROVIDED", "code_information": [{"code": "4470F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICG ANGIOGRAPHY I&R UNI/BI", "code_information": [{"code": "92240", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST DRUG/BUG", "code_information": [{"code": "95024", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST-DELAYED", "code_information": [{"code": "95028", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TITRATE-AIRBORN", "code_information": [{"code": "95027", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ID ASPERGILLUS DNA 4 SPECIES", "code_information": [{"code": "109U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX EACH ADDL NJX", "code_information": [{"code": "709T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX PREP & 1ST NJX", "code_information": [{"code": "708T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDARUBICIN HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9211", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.3, "maximum": 631.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDECABTAGENE VICLEUCEL CAR", "code_information": [{"code": "Q2055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDENTIFY SPERM TISSUE", "code_information": [{"code": "89264", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 299.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 299.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDET 1 OR MORE LEVELS", "code_information": [{"code": "22527", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDET SINGLE LEVEL", "code_information": [{"code": "22526", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDH1 (isocitrate dehydrogenase 1 [NADP+]), IDH2 (isocitrate dehydrogenase 2 [NADP+]), and TERT (telomerase reverse transcriptase) promoter (eg, central nervous system [CNS] tumors), next-generation sequencing (single-nucleotide variants [SNV], deletions, ", "code_information": [{"code": "481U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDH1 COMMON VARIANTS", "code_information": [{"code": "81120", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 222.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 222.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDH2 COMMON VARIANTS", "code_information": [{"code": "81121", "type": "CPT"}], "standard_charges": [{"minimum": 340.16, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 340.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDURSULFASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1743", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IDX EVT DTE PHQ>9 DOC 12 MO", "code_information": [{"code": "G9511", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IFE AND PE RANDOM URINE", "code_information": [{"code": "84166", "type": "CPT"}, {"code": "1000779", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.5, "maximum": 99.0, "gross_charge": 110.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFE AND PE SERUM", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "1000314", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.7, "maximum": 49.54, "gross_charge": 55.05, "discounted_cash": 54.17, "estimated_discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFE AND PE URINE 24 HR", "code_information": [{"code": "84166", "type": "CPT"}, {"code": "1000482", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.5, "maximum": 99.0, "gross_charge": 110.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFNL3 GENE", "code_information": [{"code": "81283", "type": "CPT"}], "standard_charges": [{"minimum": 84.38, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 84.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IFOSFAMIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9208", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IG LIGHT CHAINS FREE EACH", "code_information": [{"code": "83521", "type": "CPT"}], "standard_charges": [{"minimum": 19.86, "maximum": 19.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IG PARAPROTEIN QUAL BLD/UR", "code_information": [{"code": "77U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IGG 1 2 3 OR 4 EACH", "code_information": [{"code": "82787", "type": "CPT"}], "standard_charges": [{"minimum": 9.22, "maximum": 96.7, "discounted_cash": 54.17, "estimated_discounted_cash": 44.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANG DIR PROBE", "code_information": [{"code": "81262", "type": "CPT"}], "standard_charges": [{"minimum": 78.83, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANGE AMP METH", "code_information": [{"code": "81261", "type": "CPT"}], "standard_charges": [{"minimum": 227.69, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 227.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IGH VARI REGIONAL MUTATION", "code_information": [{"code": "81263", "type": "CPT"}], "standard_charges": [{"minimum": 338.7, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 338.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IGH@/BCL2 TRANSLOCATION ALYS", "code_information": [{"code": "81278", "type": "CPT"}], "standard_charges": [{"minimum": 238.41, "maximum": 238.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IGK REARRANGEABN CLONAL POP", "code_information": [{"code": "81264", "type": "CPT"}], "standard_charges": [{"minimum": 198.64, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 198.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV ADJUVANT VACCINE IM", "code_information": [{"code": "90653", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV NO PRSV INCREASED AG IM", "code_information": [{"code": "90662", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV VACC PANDEMIC ADJUVT IM", "code_information": [{"code": "90667", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV VACCINE PANDEMIC IM", "code_information": [{"code": "90668", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90655", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.5 ML IM", "code_information": [{"code": "90656", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90657", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90685", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.5 ML IM", "code_information": [{"code": "90686", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90687", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90688", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IKBKAP GENE", "code_information": [{"code": "81260", "type": "CPT"}], "standard_charges": [{"minimum": 45.21, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILEOSTOMY/JEJUNOSTOMY", "code_information": [{"code": "44310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILIAC ART ANGIO,CARDIAC CATH", "code_information": [{"code": "G0278", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILIAC BONE GRAFT MICROVASC", "code_information": [{"code": "20956", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC", "code_information": [{"code": "37220", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC ADD-ON", "code_information": [{"code": "37222", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT", "code_information": [{"code": "37221", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT ADD-ON", "code_information": [{"code": "37223", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILOPROST NON-COMP UNIT DOSE", "code_information": [{"code": "Q4074", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER CMPL", "code_information": [{"code": "263T", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER HRVST ONL", "code_information": [{"code": "265T", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER XCL HRVST", "code_information": [{"code": "264T", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAG NO LES", "code_information": [{"code": "G9551", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAG REC", "code_information": [{"code": "G9550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID COLXN VISC", "code_information": [{"code": "49405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID PERI/RETRO", "code_information": [{"code": "49406", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID TRNS/VGNL", "code_information": [{"code": "49407", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGE NOT STD NOMENCLATURE", "code_information": [{"code": "G9319", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGE STD NOMENCLATURE", "code_information": [{"code": "G9318", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGE TEST REF CAROT DIAM", "code_information": [{"code": "3100F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGING COIL, MR, INSERTABLE", "code_information": [{"code": "C1770", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGING STUDY ORDERED (BKP)", "code_information": [{"code": "3330F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMATINIB 100 MG", "code_information": [{"code": "S0088", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMDUR ER (ISOSORBIDE MONO)TAB 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000253", "type": "CDM"}, {"code": "59651053901", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IMFLUOR 1ST 1ANTB STAIN PX", "code_information": [{"code": "88346", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 162.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 162.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMFLUOR EA ADDL 1ANTB STN PX", "code_information": [{"code": "88350", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 125.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMG GID FLU COLL DRG SFT TIS", "code_information": [{"code": "10030", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMG HD ABNML NEURO EXAM", "code_information": [{"code": "G2189", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMG HD CLIN TRIAL", "code_information": [{"code": "G9537", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMG HEAD (CT OR MRI) OBTND", "code_information": [{"code": "M1027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS PHY/QHP", "code_information": [{"code": "92228", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS POC ALY", "code_information": [{"code": "92229", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETCJ/MNTR DS STAFF", "code_information": [{"code": "92227", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMHCHEM/IMCYTCHM 1ST ANTB", "code_information": [{"code": "88342", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 107.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 107.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMHCHEM/IMCYTCHM EA ADD ANTB", "code_information": [{"code": "88341", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 94.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 94.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMHCHEM/IMCYTCHM EA MLT ANTB", "code_information": [{"code": "88344", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 180.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 180.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMITREX (SUMATRIPTAN SUCC) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000241", "type": "CDM"}, {"code": "00173073500", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 54.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IMITREX (SUMATRIPTAN) 50MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000714", "type": "CDM"}, {"code": "55111029236", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IMITREX (SUMATRIPTAN) 6MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3030", "type": "HCPCS"}, {"code": "7000242", "type": "CDM"}, {"code": "64679072801", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 114.37, "maximum": 180.58, "gross_charge": 200.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 150.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 160.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 180.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 114.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMITREX (SUMAtriptan Succ) 100mg TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002484", "type": "CDM"}, {"code": "65862014836", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IMM CKPT INHIB NOT HLD NO RX", "code_information": [{"code": "M1185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMED MAN PART DENTURE RESIN", "code_information": [{"code": "D5222", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMED MAND PART DENT METAL", "code_information": [{"code": "D5224", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMED MAND PART DENTURE", "code_information": [{"code": "D5228", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMED MAX PART DENT METAL", "code_information": [{"code": "D5223", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMED MAX PART DENTURE", "code_information": [{"code": "D5227", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMED MAX PART DENTURE RESIN", "code_information": [{"code": "D5221", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMNTX 1 STING INSECT", "code_information": [{"code": "95130", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMNTX 2 STING INSECTS", "code_information": [{"code": "95131", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMNTX 3 STING INSECTS", "code_information": [{"code": "95132", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMNTX 4 STING INSECTS", "code_information": [{"code": "95133", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMNTX 5 STING INSECTS", "code_information": [{"code": "95134", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMNTX ADMN ELECTROPORATN IM", "code_information": [{"code": "732T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMOBILIZER KNEE LG 19", "code_information": [{"code": "3000209", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 75.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IMMUNE COMPLEX C1q BINDING", "code_information": [{"code": "86332", "type": "CPT"}, {"code": "1000594", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.03, "maximum": 129.84, "gross_charge": 144.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 115.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 129.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 82.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNE GLOBULIN, POWDER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1566", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNFIX E-PHORSIS/URINE/CSF", "code_information": [{"code": "86335", "type": "CPT"}], "standard_charges": [{"minimum": 33.75, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN <18 W/MD", "code_information": [{"code": "90460", "type": "CPT"}, {"code": "11000270", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 39.79, "maximum": 122.64, "gross_charge": 69.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 52.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 55.84, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 62.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 39.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN <18 W/MD ADDL", "code_information": [{"code": "90461", "type": "CPT"}, {"code": "11000271", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 20.29, "maximum": 122.64, "gross_charge": 35.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN-1ST DOSE-NASAL/ORAL", "code_information": [{"code": "90473", "type": "CPT"}, {"code": "11000260", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 157.14, "gross_charge": 174.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN-1ST INJECTION", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "11000258", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 157.14, "gross_charge": 174.6, "discounted_cash": 54.17, "estimated_discounted_cash": 174.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN-ADDL DOSE-NASAL/ORAL", "code_information": [{"code": "90474", "type": "CPT"}, {"code": "11000261", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 20.29, "maximum": 122.64, "gross_charge": 35.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN-ADDL INJECTION", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "11000259", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 46.18, "maximum": 122.64, "gross_charge": 81.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 60.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.82, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION COUNSELING", "code_information": [{"code": "D1301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNIZE COUNS < 21YR 5-15 M", "code_information": [{"code": "G0312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNIZE COUNS < 21YR 6-30 M", "code_information": [{"code": "G0313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNIZE COUNSEL 16-30 MINS", "code_information": [{"code": "G0311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNIZE COUNSEL 5-15 MIN", "code_information": [{"code": "G0310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY DIPSTICK", "code_information": [{"code": "83518", "type": "CPT"}], "standard_charges": [{"minimum": 11.09, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY INFECTIOUS AGENT", "code_information": [{"code": "86317", "type": "CPT"}], "standard_charges": [{"minimum": 17.24, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY TUMOR OTHER", "code_information": [{"code": "86316", "type": "CPT"}], "standard_charges": [{"minimum": 23.93, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY TUMOR QUAL", "code_information": [{"code": "86294", "type": "CPT"}], "standard_charges": [{"minimum": 29.41, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNODIFFUSION NES", "code_information": [{"code": "86329", "type": "CPT"}], "standard_charges": [{"minimum": 16.16, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNODIFFUSION OUCHTERLONY", "code_information": [{"code": "86331", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOFIXATION SERUM", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "1000678", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.7, "maximum": 49.54, "gross_charge": 55.05, "discounted_cash": 54.17, "estimated_discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOGLOBULIN A QUANT", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "1000558", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.7, "maximum": 49.54, "gross_charge": 55.05, "discounted_cash": 54.17, "estimated_discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOGLOBULIN ASSAY", "code_information": [{"code": "86023", "type": "CPT"}], "standard_charges": [{"minimum": 14.33, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOGLOBULIN E, TOTAL", "code_information": [{"code": "82785", "type": "CPT"}, {"code": "1000493", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.93, "maximum": 87.75, "gross_charge": 97.5, "discounted_cash": 54.17, "estimated_discounted_cash": 97.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOGLOBULIN G SUBCLASSES 1-4", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "1000945", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.7, "maximum": 49.54, "gross_charge": 55.05, "discounted_cash": 54.17, "estimated_discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOGLOBULIN M QUANTITATIVE", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "1000944", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.7, "maximum": 49.54, "gross_charge": 55.05, "discounted_cash": 54.17, "estimated_discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNOHISTOCHEMICAL STAINS", "code_information": [{"code": "D0478", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.12, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOLOGY PROCEDURE", "code_information": [{"code": "86849", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOSUPPRESSIVE DRUG NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7599", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY 2/> INJECTIONS", "code_information": [{"code": "95125", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY INJECTIONS", "code_information": [{"code": "95117", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY ONE INJECTION", "code_information": [{"code": "95115", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY ONE INJECTION", "code_information": [{"code": "95120", "type": "CPT"}], "standard_charges": [{"minimum": 74.19, "maximum": 74.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMODIUM (LOPERAMIDE) CAP 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000291", "type": "CDM"}, {"code": "57896038125", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IMP CROWN BASE ALLOYS", "code_information": [{"code": "D6086", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP CROWN PORC TO BASE ALLOY", "code_information": [{"code": "D6082", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP CROWN PORC TO NOBLE ALLO", "code_information": [{"code": "D6083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP CROWN PORC TO TITANIUM", "code_information": [{"code": "D6084", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP CROWN TITANIUM ALLOYS", "code_information": [{"code": "D6088", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP RETAIN PORC TO BASE ALLO", "code_information": [{"code": "D6098", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP RETAIN PORC TO TITANIUM", "code_information": [{"code": "D6120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP RETAINER FOR FPD", "code_information": [{"code": "D6099", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT FIXED DENT PART MAN", "code_information": [{"code": "D6117", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT FIXED DENT PART MAX", "code_information": [{"code": "D6116", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT INT FIXED DENT MAN", "code_information": [{"code": "D6118", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT REM DENT PART MAND", "code_information": [{"code": "D6113", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT REM DENT PART MAX", "code_information": [{"code": "D6112", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REM BONY W/COMP", "code_information": [{"code": "D7241", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV COMP BONY", "code_information": [{"code": "D7240", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV PART BONY", "code_information": [{"code": "D7230", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV SOFT TISS", "code_information": [{"code": "D7220", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPL ABSRB MSH/PRSTH DLY CLS", "code_information": [{"code": "15778", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP<100", "code_information": [{"code": "69716", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69729", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SKULL PERQ ESP", "code_information": [{"code": "69714", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPL/REDO ELECTRD ANTRUM", "code_information": [{"code": "43881", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT AUDITORY BRAIN IMP", "code_information": [{"code": "S2235", "type": "HCPCS"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61531", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61533", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT COCHLEAR DEVICE", "code_information": [{"code": "69930", "type": "CPT"}], "standard_charges": [{"minimum": 89519.07, "maximum": 89519.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 89519.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT CONNECTING BAR", "code_information": [{"code": "D6055", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT CROWN NOBLE ALLOYS", "code_information": [{"code": "D6087", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT EYE DRUG SYSTEM", "code_information": [{"code": "67027", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT HORMONE PELLET(S)", "code_information": [{"code": "11980", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT MAINTENANCE", "code_information": [{"code": "D6080", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT MANDIBLE FOR AUGMENT", "code_information": [{"code": "D7996", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT MID EAR HEARING PROS", "code_information": [{"code": "V5095", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NERVE END", "code_information": [{"code": "64787", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61864", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61868", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61863", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61867", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61850", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "63650", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "63655", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64553", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64555", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64561", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROSTIM ARRAYS", "code_information": [{"code": "61886", "type": "CPT"}], "standard_charges": [{"minimum": 65922.57, "maximum": 65922.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 65922.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT PROCEDURE", "code_information": [{"code": "D6199", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT RADIATION DOSIMETER", "code_information": [{"code": "A4650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SEMI-IMP HEAR", "code_information": [{"code": "S2230", "type": "HCPCS"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CANAL CATH", "code_information": [{"code": "62350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CANAL CATH", "code_information": [{"code": "62351", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62361", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62362", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED CROWN", "code_information": [{"code": "D6065", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED MTL CROWN", "code_information": [{"code": "D6066", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED MTL CROWN", "code_information": [{"code": "D6067", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6075", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6076", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6077", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT TCAT PULM VLV PERQ", "code_information": [{"code": "33477", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT URETER IN BOWEL", "code_information": [{"code": "50800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33975", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33976", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT/INSERT DEVICE, NOC", "code_information": [{"code": "C1889", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT/REPLACE HEARING AID", "code_information": [{"code": "69710", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANTABLE ACCESS SYST PERC", "code_information": [{"code": "A4301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANTABLE TISSUE MARKER", "code_information": [{"code": "A4648", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLNT,BON VOID FILLER-PUTTY", "code_information": [{"code": "C9359", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLNT,BON VOID FILLER-STRIP", "code_information": [{"code": "C9362", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLNT/ABUT FIXED DENT MAND", "code_information": [{"code": "D6115", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLNT/ABUT FIXED DENT MAX", "code_information": [{"code": "D6114", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLNT/ABUT REMOV DENT MAND", "code_information": [{"code": "D6111", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLNT/ABUT REMOV DENT MAX", "code_information": [{"code": "D6110", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT ANT SGM IO NBIO RX SYS", "code_information": [{"code": "660T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT BRAIN CHEMOTX ADD-ON", "code_information": [{"code": "61517", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT CRAN BONE FLAP TO ABDO", "code_information": [{"code": "61316", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT NEUROSTIM ELCTR EACH", "code_information": [{"code": "L8680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT NROSTM PLS GEN DUA NON", "code_information": [{"code": "L8688", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT NROSTM PLS GEN DUA REC", "code_information": [{"code": "L8687", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT NROSTM PLS GEN SNG NON", "code_information": [{"code": "L8686", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT NROSTM PLS GEN SNG REC", "code_information": [{"code": "L8685", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV GEN", "code_information": [{"code": "268T", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV LEAD", "code_information": [{"code": "267T", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV TOTAL", "code_information": [{"code": "266T", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLTJ NTRSTRML CRNL RNG SEG", "code_information": [{"code": "65785", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLTJ SYNTH RNFCMT ABDL WAL", "code_information": [{"code": "437T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLTJ TOT RPLCMT HRT SYS", "code_information": [{"code": "33927", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPORTED LIPODOX INJ", "code_information": [{"code": "Q2049", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPR MED TIME EDARR PAIN MED", "code_information": [{"code": "G9426", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPR VIS ACUIT W/IN 90D", "code_information": [{"code": "G9516", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPRESSION CASTING FT", "code_information": [{"code": "S0395", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPROVE VISUAL FUNCT", "code_information": [{"code": "G0913", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPRV CARE LE JNT REPR MVP", "code_information": [{"code": "G0058", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMTERPRETE DIAGNOSTIC IMAGE", "code_information": [{"code": "D0391", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMUGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1786", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN & OUT CATERTERIZATION TECH", "code_information": [{"code": "51701", "type": "CPT"}, {"code": "11000066", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN EAR BINAURAL HEARING AID", "code_information": [{"code": "V5130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN GEMCITABINE HCL NOS 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN GNOTYP CD44 EXONS 2 3 6", "code_information": [{"code": "191U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN-HOSPITAL ON CALL SERVICE", "code_information": [{"code": "99026", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN-PERSON ATTENDANCE G CODE", "code_information": [{"code": "G9886", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN111 CAPROMAB", "code_information": [{"code": "A9507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN111 IBRITUMOMAB, DX", "code_information": [{"code": "A9542", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN111 OXYQUINOLINE", "code_information": [{"code": "A9547", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN111 PENTETATE", "code_information": [{"code": "A9548", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN111 SATUMOMAB", "code_information": [{"code": "A4642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INACTIVATED JE VACC IM", "code_information": [{"code": "90738", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [{"code": "642", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INC DP OPN B1 CRTX HUM/ELBW", "code_information": [{"code": "23935", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INC THYR NODE <1.0 IN RPT", "code_information": [{"code": "G9552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN EA SEP/ADDL", "code_information": [{"code": "11107", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN SINGLE LES", "code_information": [{"code": "11106", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCID PULM NODULE", "code_information": [{"code": "G9754", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG CERV", "code_information": [{"code": "22210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG LUMBAR", "code_information": [{"code": "22214", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG THORAC", "code_information": [{"code": "22212", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS ADDL SPINE SEGMENT", "code_information": [{"code": "22216", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN ADL SEG", "code_information": [{"code": "22208", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN LUMBAR", "code_information": [{"code": "22207", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN THORAC", "code_information": [{"code": "22206", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE & DRAIN BLADDER", "code_information": [{"code": "51040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE BILE DUCT SPHINCTER", "code_information": [{"code": "47460", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE BLADDER/DRAIN URETER", "code_information": [{"code": "51045", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE DIAPHRAGM NERVE", "code_information": [{"code": "64746", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE FINGER TENDON SHEATH", "code_information": [{"code": "26055", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE FLEXOR CARPI RADIALIS", "code_information": [{"code": "25001", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE HAND/FINGER TENDON", "code_information": [{"code": "26460", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64763", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64766", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR", "code_information": [{"code": "69801", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69915", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69950", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65865", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65870", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65875", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65880", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE STRANDS", "code_information": [{"code": "67030", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE NERVE BACK OF HEAD", "code_information": [{"code": "64744", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL (PRESS RELIEF)", "code_information": [{"code": "61343", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61458", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61571", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61460", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR TREATMENT", "code_information": [{"code": "61770", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL REPAIR", "code_information": [{"code": "62121", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN BIOPSY", "code_information": [{"code": "61750", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61720", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61735", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61556", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61557", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPINAL CORD TRACT(S)", "code_information": [{"code": "63170", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE ACCESSORY NERVE", "code_information": [{"code": "63191", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV >2 SEGMNTS", "code_information": [{"code": "63190", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV HALF SEGMNT", "code_information": [{"code": "63185", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE TEAR DUCT OPENING", "code_information": [{"code": "68440", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE TENDON(S) & MUSCLE(S)", "code_information": [{"code": "23406", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE THIGH TENDON & FASCIA", "code_information": [{"code": "27305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE WRIST/FOREARM TENDON", "code_information": [{"code": "25290", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN EYELID LINING", "code_information": [{"code": "68020", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR GLAND", "code_information": [{"code": "68400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR SAC", "code_information": [{"code": "68420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE/GRAFT MIDFOOT BONES", "code_information": [{"code": "28305", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27605", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL ABSCESS", "code_information": [{"code": "46050", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SEPTUM", "code_information": [{"code": "46070", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SPHINCTER", "code_information": [{"code": "46080", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANKLE BONE", "code_information": [{"code": "28302", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61541", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61567", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BROW NERVE", "code_information": [{"code": "64732", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BURN SCAB INITI", "code_information": [{"code": "16035", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHEEK NERVE", "code_information": [{"code": "64734", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHIN NERVE", "code_information": [{"code": "64736", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF COLLARBONE JOINT", "code_information": [{"code": "23106", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69420", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69421", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43045", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "65850", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "66172", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID", "code_information": [{"code": "67710", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID FOLD", "code_information": [{"code": "67715", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF FACIAL NERVE", "code_information": [{"code": "64742", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF FIBULA", "code_information": [{"code": "27707", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26455", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT FASCIA", "code_information": [{"code": "28008", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT TENDON", "code_information": [{"code": "28234", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT TENDON(S)", "code_information": [{"code": "28230", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47480", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47490", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33025", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEEL BONE", "code_information": [{"code": "28300", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONE", "code_information": [{"code": "27146", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONES", "code_information": [{"code": "27151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27003", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDONS", "code_information": [{"code": "27006", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP/THIGH FASCIA", "code_information": [{"code": "27025", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66500", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66505", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW JOINT", "code_information": [{"code": "21010", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW NERVE", "code_information": [{"code": "64738", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF KNEE JOINT", "code_information": [{"code": "27435", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF LARGE BOWEL", "code_information": [{"code": "44025", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIP FOLD", "code_information": [{"code": "40806", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIVER DUCT", "code_information": [{"code": "47400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF LYMPH CHANNELS", "code_information": [{"code": "38308", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28306", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28307", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28308", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSALS", "code_information": [{"code": "28309", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF MIDFOOT BONES", "code_information": [{"code": "28304", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF NECK OF FEMUR", "code_information": [{"code": "27161", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF PALM TENDON", "code_information": [{"code": "26450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF PROSTATE", "code_information": [{"code": "52450", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF PYLORIC MUSCLE", "code_information": [{"code": "43520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46040", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46045", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46060", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF SMALL BOWEL", "code_information": [{"code": "44010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPERM DUCT", "code_information": [{"code": "55200", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPINAL NERVE", "code_information": [{"code": "64772", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF STOMACH NERVES", "code_information": [{"code": "64755", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON & MUSCLE", "code_information": [{"code": "23405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON SHEATH", "code_information": [{"code": "25000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27448", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27306", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27390", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27307", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27391", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27392", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA", "code_information": [{"code": "27705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA & FIBULA", "code_information": [{"code": "27709", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28232", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDONS", "code_information": [{"code": "28011", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE FOLD", "code_information": [{"code": "41010", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE NERVE", "code_information": [{"code": "64740", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53000", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53010", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53020", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53025", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF VAGUS NERVE", "code_information": [{"code": "64760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31600", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31601", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31603", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31605", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31610", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF WRIST CAPSULE", "code_information": [{"code": "25085", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION SECONDARY CATARACT", "code_information": [{"code": "66820", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION, THROMBOSED HEMORRHOID EXTERNAL", "code_information": [{"code": "46083", "type": "CPT"}, {"code": "11000286", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 392.49, "maximum": 619.73, "gross_charge": 688.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 516.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 550.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 619.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 392.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION/DRAIN ABSCESS EXTRA", "code_information": [{"code": "D7521", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION/DRAIN ABSCESS INTRA", "code_information": [{"code": "D7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION/FIXATION OF FEMUR", "code_information": [{"code": "27165", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCOBOTULINUMTOXIN A", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0588", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCOMPL DONOR EGG CASE RATE", "code_information": [{"code": "S4023", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCOMPLETE ENDODONTIC TX", "code_information": [{"code": "D3332", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCON DISPOSABLE PENILE WRAP", "code_information": [{"code": "T4545", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCONTINENCE GARMENT ANYTYPE", "code_information": [{"code": "A4520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCONTINENCE SUPPLY", "code_information": [{"code": "A4335", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCONTINENT RECTAL INSERT", "code_information": [{"code": "A4337", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCRUSE ELLIPTA INH PWD 62.5MCG/1ACT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001924", "type": "CDM"}, {"code": "00173087310", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IND IMG HD POS HD ACHE", "code_information": [{"code": "G2191", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IND IMG HD RAD NECK", "code_information": [{"code": "G2190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDERAL (PROPRANOLOL) 1 MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1800", "type": "HCPCS"}, {"code": "7000243", "type": "CDM"}, {"code": "00143987201", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDERAL (PROPRANOLOL) INJ 1MG/ML :", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1800", "type": "HCPCS"}, {"code": "7000244", "type": "CDM"}, {"code": "10019014501", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.56, "maximum": 7.2, "gross_charge": 8.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 6.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDERAL (PROPRANOLOL) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001023", "type": "CDM"}, {"code": "50268066215", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INDERAL (PROPRANOLOL) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000907", "type": "CDM"}, {"code": "00904746806", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INDERAL (PROPRANOLOL) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000397", "type": "CDM"}, {"code": "50268066415", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INDERAL LA (PROPRANOLOL HCL ER) 120MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001072", "type": "CDM"}, {"code": "51991081901", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INDERAL LA (PROPRANOLOL HCL ER) 60MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002480", "type": "CDM"}, {"code": "60687021501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INDERAL LA (PROPRANOLOL) CAP 80MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000245", "type": "CDM"}, {"code": "00527411737", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INDEXING FOR OSTEOTOMY", "code_information": [{"code": "D7939", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIC FOR HEAD CT NOT VALID", "code_information": [{"code": "G9533", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIRECT IMMUNOFLUORESCENCE", "code_information": [{"code": "D0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.12, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIUM IN-111 AUTO PLATELET", "code_information": [{"code": "A9571", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIUM IN-111 AUTO WBC", "code_information": [{"code": "A9570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIUM IN-111 PENTETREOTIDE", "code_information": [{"code": "A9572", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIV PDC > 0.8", "code_information": [{"code": "G9512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIV PDC NOT > 0.8", "code_information": [{"code": "G9513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDOMETHACIN (INDOCIN) CAP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000246", "type": "CDM"}, {"code": "68462040601", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INDUCED ABORTION 17-24 WEEKS", "code_information": [{"code": "S2260", "type": "HCPCS"}], "standard_charges": [{"minimum": 5637.45, "maximum": 5637.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION 25-28 WKS", "code_information": [{"code": "S2265", "type": "HCPCS"}], "standard_charges": [{"minimum": 5637.45, "maximum": 5637.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION 29-31 WKS", "code_information": [{"code": "S2266", "type": "HCPCS"}], "standard_charges": [{"minimum": 5637.45, "maximum": 5637.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION 32 OR MORE", "code_information": [{"code": "S2267", "type": "HCPCS"}], "standard_charges": [{"minimum": 5637.45, "maximum": 5637.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDUCTION OF VOMITING", "code_information": [{"code": "99175", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDX SUICD IDEA, NO 0 SCR", "code_information": [{"code": "M1359", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDX WHODAS 2.0 OR SDS", "code_information": [{"code": "M1340", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INELIG FOOTWR EVAL", "code_information": [{"code": "G2180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFANT SAFETY CLASS", "code_information": [{"code": "S9447", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFECT CONTROL SUPPLIES NOS", "code_information": [{"code": "S8301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "758", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "757", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "759", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "854", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "853", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "855", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS DISEASE SS", "code_information": [{"code": "G4010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFILTRATION THERA DRUG", "code_information": [{"code": "D9613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "727", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [{"code": "728", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE PANEL", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "1000937", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 96.7, "gross_charge": 71.34, "discounted_cash": 54.17, "estimated_discounted_cash": 71.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [{"code": "386", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [{"code": "385", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC", "code_information": [{"code": "387", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INFLIXIMAB NOT BIOSIMIL 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1745", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA A/B EACH AG IA", "code_information": [{"code": "87400", "type": "CPT"}], "standard_charges": [{"minimum": 16.25, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA ASSAY W/OPTIC", "code_information": [{"code": "87804", "type": "CPT"}], "standard_charges": [{"minimum": 19.03, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB 1+", "code_information": [{"code": "87501", "type": "CPT"}], "standard_charges": [{"minimum": 59.01, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB ADDL", "code_information": [{"code": "87503", "type": "CPT"}], "standard_charges": [{"minimum": 33.6, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROBE", "code_information": [{"code": "87502", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 110.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 110.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA IMM ORDER/ADMIN", "code_information": [{"code": "4037F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA IMM REC", "code_information": [{"code": "4035F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA IMM STATUS ASSESS", "code_information": [{"code": "1030F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA RAPID TEST A/B", "code_information": [{"code": "87275", "type": "CPT"}, {"code": "1000287", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.09, "maximum": 63.9, "gross_charge": 71.01, "discounted_cash": 54.17, "estimated_discounted_cash": 71.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS ANTIBODY", "code_information": [{"code": "86710", "type": "CPT"}], "standard_charges": [{"minimum": 15.58, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS VACCINE, NOS", "code_information": [{"code": "Q2039", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFRARED HEATING PAD SYSTEM", "code_information": [{"code": "E0221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFRARED THERAPY", "code_information": [{"code": "97026", "type": "CPT"}], "standard_charges": [{"minimum": 5.96, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61590", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61591", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUS INSULIN PUMP NON NEEDL", "code_information": [{"code": "A4230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSE RADIOACTIVE MATERIALS", "code_information": [{"code": "77750", "type": "CPT"}], "standard_charges": [{"minimum": 645.92, "maximum": 645.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 645.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION INSULIN PUMP NEEDLE", "code_information": [{"code": "A4231", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP REFILL KIT", "code_information": [{"code": "A4220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP, NON-PROG,TEMP", "code_information": [{"code": "C2626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP, PROGRAMMABLE", "code_information": [{"code": "C1772", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP,NON-PROG, PERM", "code_information": [{"code": "C1891", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION SUPPLIES W/O PUMP", "code_information": [{"code": "A4223", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION THERAPY CHEMO", "code_information": [{"code": "96413", "type": "CPT"}, {"code": "10000002", "type": "CDM"}, {"code": "335", "type": "RC"}], "standard_charges": [{"minimum": 125.4, "maximum": 966.98, "gross_charge": 220.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 169.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 176.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 198.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 125.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE ADDL 60 MIN", "code_information": [{"code": "95079", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE INI 120 MIN", "code_information": [{"code": "95076", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [{"code": "351", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [{"code": "350", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "352", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INHALATION SOLUTION FOR DME", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7699", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INHALED BRONCHODILATOR RX", "code_information": [{"code": "4025F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INHALED CORTICOSTEROIDS RXD", "code_information": [{"code": "4140F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INHIBIN A", "code_information": [{"code": "86336", "type": "CPT"}], "standard_charges": [{"minimum": 17.93, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INHIBIN A", "code_information": [{"code": "86337", "type": "CPT"}, {"code": "1000900", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.62, "maximum": 107.16, "gross_charge": 119.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 107.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 67.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHLNT ANESTH ONLY FOR INDUC", "code_information": [{"code": "G9955", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INI PHQ9 >9 NO REMISS >=5", "code_information": [{"code": "G9395", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INI PHQ9 >9 NOT ASSESS", "code_information": [{"code": "G9396", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INI PHQ9 >9 REMISS <5", "code_information": [{"code": "G9393", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT DAY HOSP NEONATE CARE", "code_information": [{"code": "99477", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT EVAL FOR CONDITION", "code_information": [{"code": "1119F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT NB EM PER DAY HOSP", "code_information": [{"code": "99460", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT NB EM PER DAY NON-FAC", "code_information": [{"code": "99461", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT 1-4 YRS", "code_information": [{"code": "99382", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT 65+ YRS", "code_information": [{"code": "99387", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT INFANT", "code_information": [{"code": "99381", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT/SUB PSYCH CARE M 1ST 30", "code_information": [{"code": "G2214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INITIAL EXAM INVOLVED JOINTS", "code_information": [{"code": "2004F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INITIAL FOOT EXAM PT LOPS", "code_information": [{"code": "G0245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INITIAL PRENATAL CARE VISIT", "code_information": [{"code": "500F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INITIAL PREVENTIVE EXAM", "code_information": [{"code": "G0402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INITIAL VISIT FOR EPISODE", "code_information": [{"code": "525F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INITIAT MED ASSIST TX IN ER", "code_information": [{"code": "G2213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ACETAMINOPHEN -FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0134", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ALLOPURINOL SODIUM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ALYMSYS 10 MG", "code_information": [{"code": "Q5126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ANDEXXA, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7169", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ANESTHETIC PER 10 ML", "code_information": [{"code": "A4737", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ANIFROLUMAB-FNIA 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0491", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ AVAL ALFA-NQPT 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0219", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ BENZTROPINE MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0515", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON IM 1 MCG", "code_information": [{"code": "Q3027", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON SQ 1 MCG", "code_information": [{"code": "Q3028", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ BIMATOPROST ITC IMP1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7351", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ BIPERIDEN LACTATE/5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, BAXTER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0689", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, HIKMA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0688", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CEFTOLOZANE TAZOBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0695", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 631.3, "maximum": 631.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CODEINE PHOSPHATE /30 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0745", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CRIZANLIZUMAB-TMCA 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0791", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CUTAQUIG 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1551", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CUVITRU, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1555", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOSPHAMD AUROMEDIC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9071", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DAUNORUBICIN, CYTARABINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9153", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DELANDISTROGENE MOX ROKL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1413", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DEOXYCHOLIC ACID, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0591", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DESMOPRESSIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2597", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DICLOFENAC SODIUM 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DIHYDROERGOTAMINE MESYLT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DUPUYTREN CORD W/ENZYME", "code_information": [{"code": "20527", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ EFGARTIGIMOD 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9332", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ EFLAPEGRASTIM-XNST 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1449", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FE-BASED MR CONTRAST,1ML", "code_information": [{"code": "Q9953", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FENSOLVI 0.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1951", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC CARBOXYMALTOS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1439", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "estimated_discounted_cash": 1085.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC PYROPHOSPHATE CIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1443", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FILGRASTIM EXCL BIOSIMIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1442", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN ALFA 75 IU", "code_information": [{"code": "S0126", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN BETA 75 IU", "code_information": [{"code": "S0128", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FOR SACROILIAC JT ANESTH", "code_information": [{"code": "G0260", "type": "HCPCS"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FOSNETUPITANT, PALONOSET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1454", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ GADOTERATE MEGLUMI 0.1ML", "code_information": [{"code": "A9575", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ GANIRELIX ACETAT 250 MCG", "code_information": [{"code": "S0132", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ GEMCITABINE HCL (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9196", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ GIVOSIRAN 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0223", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ GLUCAGON HCL, FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN, PFIZER, 1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1643", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ HERZUMA 10 MG", "code_information": [{"code": "Q5113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ HYDROXYPROGST CAPOAT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1729", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ LABETALOL HCL HIKMA, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1921", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ LEFAMULIN 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0691", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ LEVOCARNITINE PER 1 GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1955", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ LUSPATERCEPT-AAMT 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0896", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MENOTROPINS 75 IU", "code_information": [{"code": "S0122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MEPIVACAINE HCL/10 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ METARAMINOL BITARTRATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MIDAZOLAM (WG CRIT CARE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2251", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MILRINONE LACTATE / 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MOGAMULIZUMAB-KPKC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MORPHINE PF EPID ITHC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MOSUNETUZUMAB-AXGB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MOXIFLOXACIN (FRES KABI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MULTIHANCE", "code_information": [{"code": "A9577", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MULTIHANCE MULTIPACK", "code_information": [{"code": "A9578", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MVASI 10 MG", "code_information": [{"code": "Q5107", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ NIVOL RELATLIMAB 3MG/1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9298", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ OCTAFLUOROPROPANE MIC,ML", "code_information": [{"code": "Q9956", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ OGIVRI 10 MG", "code_information": [{"code": "Q5114", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ OLIPUDASE ALFA-RPCP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0218", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ONASE ABEPAR-XIOI TREAT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ONTRUZANT 10 MG", "code_information": [{"code": "Q5112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 1 LEV", "code_information": [{"code": "64490", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 2 LEV", "code_information": [{"code": "64491", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 3 LEV", "code_information": [{"code": "64492", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 1 LEV", "code_information": [{"code": "64493", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 2 LEV", "code_information": [{"code": "64494", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 3 LEV", "code_information": [{"code": "64495", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRAST EX BIO 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2506", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRASTIM-BMEZ 0.5MG", "code_information": [{"code": "Q5120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEMBROLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (ACCORD) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9296", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (BLUEPOINT)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9322", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (SANDOZ) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9297", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (TEVA) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9314", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED DITROMETHAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9323", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED, HOSPIRA 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PERFLEXANE LIP MICROS,ML", "code_information": [{"code": "Q9955", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PERFLUTREN LIP MICROS,ML", "code_information": [{"code": "Q9957", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PHENYLEPHRINE HCL 20 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2371", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PLASMINOGEN TVMH 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2998", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PROGESTERONE PER 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2675", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PROHANCE MULTIPACK", "code_information": [{"code": "A9576", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PROTIRELIN PER 250 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2725", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ RECOMBIN ESPEROCT PER IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT ESRD ON DIALYSI", "code_information": [{"code": "Q5105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ RISANKIZUMAB-RZAA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2327", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ RITUXIMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN LYOPHIL 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9319", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ RONZANOLIXIZUM-NOLI 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9333", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ RUXIENCE, 10 MG", "code_information": [{"code": "Q5119", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ SECRETIN SYNTHETIC HUMAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2850", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ SODIUM THIOSULFATE 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ SQ/IM, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "11000238", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 157.14, "gross_charge": 174.6, "discounted_cash": 54.17, "estimated_discounted_cash": 250.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SQ/IM, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "11000284", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 157.14, "gross_charge": 174.6, "discounted_cash": 54.17, "estimated_discounted_cash": 250.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ STREPTOKINASE /250000 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2995", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ SULF HEXA LIPID MICROSPH", "code_information": [{"code": "Q9950", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TALIMOGENE LAHERPAREPVEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TEDIZOLID PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3090", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TENDON ORIGIN/INSERTION", "code_information": [{"code": "20551", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TEPLIZUMAB MZWV 5 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9381", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TESTOSTERO ENANTHATE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TEZEPELUMAB-EKKO, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ THEOPHYLLINE PER 40 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2810", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TISOTU VEDOTIN-TFTV, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TOFERSEN INTRATHEC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1304", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TRASTUZUMAB EXCL BIOSIMI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TRIAMCINOLONE ACE XR 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3304", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TRIGGER POINT 1/2 MUSCL", "code_information": [{"code": "20552", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TRIMETREXATE GLUCORONATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TRUXIMA 10 MG", "code_information": [{"code": "Q5115", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ UBLITUXIMAB-XIIY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2329", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ XIPERE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ABILIFY ASIMTUFII, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (B BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (HIKMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0137", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (NOS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0131", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ADUCANUMAB-AVWA, 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ALFENTANIL HCL, 500MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, AMIODARONE (NEXTERONE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0283", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, AMISULPRIDE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0184", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, AMIVANTAMAB-VMJW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9061", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, APONVIE, 1 MG", "code_information": [{"code": "C9145", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ARTESUNATE, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0391", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ASPARA, RYLAZE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ATEZOLIZUMAB,10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9022", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BENDAMUSTINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9056", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BEZLOTOXUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0565", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BIORPHEN, 20 MICROGRAMS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB (MAIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB FRESENIUSKAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9048", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, DR. REDDY'S", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, HOSPIRA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9049", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BROLUCIZUMAB-DBLL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0179", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BUMETANIDE, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1939", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BUPIVACAINE (POSIMIR)", "code_information": [{"code": "C9144", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, CABAZITAXEL (SANDOZ)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9064", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, CABOTE RILPIVIR 2MG 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0741", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, CARMUSTINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, CEFEPIME HCL (B BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0703", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, CIMERLI, 0.1 MG", "code_information": [{"code": "Q5128", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, CLEVIDIPINE BUTYRATE", "code_information": [{"code": "C9248", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0874", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (HOSPIRA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0877", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (XELLIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0873", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, DECITABINE (SUN PHARMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0893", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, DOSTARLIMAB-GXLY, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9272", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, DUROLANE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7318", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ELAHERE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9063", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, EPIRUBICIN HCL, 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9178", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ESMOLOL HCL, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1805", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ETELCALCETIDE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0606", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ETEPLIRSEN, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1428", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, EVINACUMAB-DGNB, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, FARICIMAB-SVOA, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2777", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, FOSAPREPITANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1456", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9394", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9393", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, FUROSCIX, 20 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1941", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, FYLNETRA, 0.5 MG", "code_information": [{"code": "Q5130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, GADOPICLENOL, 1 ML", "code_information": [{"code": "A9573", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, GANCICLOVIR (EXELA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1574", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, GLYCOPYRROLATE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1596", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, GRANISETRON, XR, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, HEMGENIX, PER TX DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1411", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, HYDROXOCOBALAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, IMM GLOB BIVIGAM, 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1556", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, INVEGA HAFYERA/TRINZA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2427", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, IXINITY, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, KOVALTRY, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7211", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, LANREOTIDE, (CIPLA) 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1932", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, LECANEMAB-IRMB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0174", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, LENACAPAVIR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, LINEZOLID (HOSPIRA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, MAGTRACE PER STUDY DOSE", "code_information": [{"code": "A9697", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, MEROPENEM (B. BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2184", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, METHOTREXATE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, MICAFUNGIN (PAR PHARM)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, MOXIFLOXACIN 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, NUSINERSEN, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2326", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, NYVEPRIA", "code_information": [{"code": "Q5122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, OCRIPLASMIN, 0.125 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7316", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, OLARATUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9285", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, OLICERIDINE 0.1 MG", "code_information": [{"code": "C9101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, OMACETAXINE MEP, 0.01MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9262", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, PAFOLACIANINE, 0.1 MG", "code_information": [{"code": "A9603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, PANZYGA, 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1576", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, PASIREOTIDE LONG ACTING", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2502", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, PEGCETACOPLAN, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2781", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, PEMRYDI RTU, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9324", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, POLATUZUMAB VEDOTIN 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9309", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, RELEUKO 1 MCG", "code_information": [{"code": "Q5125", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, REMIMAZOLAM, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, RETIFANLIMAB-DLWR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9345", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, REZAFUNGIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0349", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, RIMABOTULINUMTOXINB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0587", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, SCULPTRA, 0.5MG", "code_information": [{"code": "Q2028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, SEZABY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2561", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, SPESOLIMAB-SBZO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1747", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, STIMUFEND, 0.5 MG", "code_information": [{"code": "Q5127", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, SUSVIMO 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2779", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, SUTIMLIMAB-JOME, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1302", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, TALIGLUCERASE ALFA 10 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3060", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, TEBENTAFUSP-TEBN, 1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, TREMELIMUMAB-ACTL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9347", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, TRIVISC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7329", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, UZEDY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2799", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, VASOPRESSIN, 1 UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2598", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, VEGZELMA, 10 MG", "code_information": [{"code": "Q5129", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, VUTRISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ZIV-AFLIBERCEPT, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9400", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. ASCENIV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1554", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. AVSOLA, 10 MG", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. BELRAPZO/BENDAMUSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. BYOOVIZ, 0.1 MG", "code_information": [{"code": "Q5124", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. CALASPARGASE PEGOL-MKNL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9118", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. CEFEPIME HCL (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0701", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. CETIRIZINE HCL 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. EPTINEZUMAB-JJMR 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. FE DERISOMALTOSE 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1437", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. HERCEPTIN HYLECTA, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. INEBILIZUMAB-CDON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1823", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. INFUGEM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9198", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (FIASP)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1812", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (LYUMJEV)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1814", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. ISATUXIMAB-IRFC 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9227", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. JIVI 1 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. LUMASIRAN, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. LURBINECTEDIN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9223", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. MARGETUXIMAB-CMKB, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. MELOXICAM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1738", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. MYCOPHENOLATE MOFETIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7519", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. NAXITAMAB-GQGK, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9348", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. OLANZAPINE, 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2359", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED NOS 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9304", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. RIABNI, 10 MG", "code_information": [{"code": "Q5123", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. ROMOSOZUMAB-AQQG 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3111", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. TAGRAXOFUSP-ERZS 10 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9269", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. TEPROTUMUMAB-TRBW 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3241", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. TIGECYCLINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3244", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. VILTOLARSEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1427", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. XEMBIFY, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1558", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., APREPITANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., ARISTADA INITIO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1943", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., BENDEKA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., BENRALIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0517", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., BREXANOLONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1632", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., CEMIPLIMAB-RWLC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9119", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., CERLIPONASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0567", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., COPANLISIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9057", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., DURVALUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9173", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., EMAPALUMAB-LZSG, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., ERAVACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., EVOMELA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., FIBRYGA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7177", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., FREMANEZUMAB-VFRM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., GUSELKUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., HAEGARDA 10 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0599", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., IBALIZUMAB-UIYK, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1746", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., KANJINTI, 10 MG", "code_information": [{"code": "Q5117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., LANADELUMAB-FLYO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0593", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., LUMOXITI, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., MEROPENEM, VABORBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., OMADACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., PATISIRAN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., PERSERIS, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2798", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., PLAZOMICIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0291", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., RAVULIZUMAB-CWVZ 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1303", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., RITUXIMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., ROLAPITANT, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2797", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., TAFASITAMAB-CXIX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9349", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., TILDRAKIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., TRAZIMERA, 10 MG", "code_information": [{"code": "Q5116", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., TREANDA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9033", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., TRILURON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7332", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., VESTRONIDASE ALFA-VJBK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3397", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., YUTIQ, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7314", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., ZIRABEV, 10 MG", "code_information": [{"code": "Q5118", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT EPIDURAL PATCH", "code_information": [{"code": "62273", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT FOR SACROILIAC JOINT", "code_information": [{"code": "G0259", "type": "HCPCS"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT SACROILIAC JOINT", "code_information": [{"code": "27096", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT SINUS TRACT FOR X-RAY", "code_information": [{"code": "20501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS </W 7", "code_information": [{"code": "11900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS >7", "code_information": [{"code": "11901", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT TRIGGER POINTS 3/>", "code_information": [{"code": "20553", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT/ASPIRATE LIVER CYST", "code_information": [{"code": "47015", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67500", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67505", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67515", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION ABDOMINAL SHUNT", "code_information": [{"code": "49427", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION ANISTREPLASE 30 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0350", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION ESTRONE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1435", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION EXT VENOGRAPHY", "code_information": [{"code": "36005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION EYE DRUG", "code_information": [{"code": "67028", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR ANKLE X-RAY", "code_information": [{"code": "27648", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47531", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47532", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP X-RAY", "code_information": [{"code": "27093", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP X-RAY", "code_information": [{"code": "27095", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR MYELOGRAM", "code_information": [{"code": "62284", "type": "CPT"}], "standard_charges": [{"minimum": 1871.2, "maximum": 1871.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1871.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SALIVARY X-RAY", "code_information": [{"code": "42550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SHOULDER X-RAY", "code_information": [{"code": "23350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SPLEEN X-RAY", "code_information": [{"code": "38200", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR TEAR SAC X-RAY", "code_information": [{"code": "68850", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50684", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50690", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR WRIST X-RAY", "code_information": [{"code": "25246", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION GLATIRAMER ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1595", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61026", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61055", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO HEMORRHOID(S)", "code_information": [{"code": "46500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO SPINAL ARTERY", "code_information": [{"code": "62294", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO VOCAL CORD", "code_information": [{"code": "31513", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION INTRAOP ADD-ON", "code_information": [{"code": "48400", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION JAW JOINT X-RAY", "code_information": [{"code": "21116", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION OF HIV PREP DRUG", "code_information": [{"code": "G0012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION OF SINUS TRACT", "code_information": [{"code": "20500", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION PX FOR ELBOW ARTHG", "code_information": [{"code": "24220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TORSEMIDE 10 MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TRABECTEDIN 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9352", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66020", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66030", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64600", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64605", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64610", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64620", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64630", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64640", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64680", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64681", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NOSE", "code_information": [{"code": "30200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, ALEMTUZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0202", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, AVELUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9023", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, AZTREONAM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0457", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, BELINOSTAT, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9032", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, BLINATUMOMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9039", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, BORTEZOMIB, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9041", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, BUROSUMAB-TWZA 1M", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0584", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CANGRELOR", "code_information": [{"code": "C9460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CAPLACIZUMAB-YHDP", "code_information": [{"code": "C9047", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CARFILZOMIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9047", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CASIMERSEN, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1426", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CEFOPERAZONE SOD", "code_information": [{"code": "S0021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CIMETIDINE HYDROC", "code_information": [{"code": "S0023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, DALBAVANCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0875", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, DARATUMUMAB 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, DELAFLOXACIN", "code_information": [{"code": "C9462", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, DEXAMETHASONE 9%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1095", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, DOXERCALCIFEROL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, EDARAVONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, ELOTUZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9176", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, FOSPHENYTOIN SODI", "code_information": [{"code": "S0078", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, FULPHILA", "code_information": [{"code": "Q5108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, FULVESTRANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9395", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, GLUCARPIDASE", "code_information": [{"code": "C9293", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, INCLISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1306", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, INFLECTRA", "code_information": [{"code": "Q5103", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, ISAVUCONAZONIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1833", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, IXIFI, 10 MG", "code_information": [{"code": "Q5109", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, KHAPZORY, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0642", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, LACOSAMIDE", "code_information": [{"code": "C9254", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, MEPOLIZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2182", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, NECITUMUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9295", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, NIVOLUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9299", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, OCRELIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2350", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, OFLOXACIN, 400 MG", "code_information": [{"code": "S0034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, ORITAVANCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2407", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, ORITAVANCIN 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2406", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, PERAMIVIR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2547", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, PERTUZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9306", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, PIPERACILLIN SODI", "code_information": [{"code": "S0081", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, RAMUCIRUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9308", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, RENFLEXIS", "code_information": [{"code": "Q5104", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, RESLIZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2786", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, RUCONEST", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0596", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, SILTUXIMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2860", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, TICARCILLIN DISOD", "code_information": [{"code": "S0040", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, TRILACICLIB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1448", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, UDENYCA 0.5 MG", "code_information": [{"code": "Q5111", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, VEDOLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3380", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, ZARXIO", "code_information": [{"code": "Q5101", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION,ONABOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0585", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INLAY COMPOSITE/RESIN ONE SU", "code_information": [{"code": "D2650", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INLAY COMPOSITE/RESIN TWO SU", "code_information": [{"code": "D2651", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INLAY PORCELAIN/CERAMIC 1 SU", "code_information": [{"code": "D2610", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INLAY PORCELAIN/CERAMIC 2 SU", "code_information": [{"code": "D2620", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INLAY REPAIR", "code_information": [{"code": "D2981", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INLAY TITANIUM", "code_information": [{"code": "D6624", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INNER SKULL VESSEL SURGERY", "code_information": [{"code": "61702", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INNOVABRN/INNOVAMATX XL SQCM", "code_information": [{"code": "A2022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INNOVAMATRIX AC, PER SQ CM", "code_information": [{"code": "A2001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INNOVAMATRIX FS, PER SQ CM", "code_information": [{"code": "A2013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INNOVAMATRIX PD, 1 MG", "code_information": [{"code": "A2023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPNT STAY RADIOLABELED ITEM", "code_information": [{"code": "C9898", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT ELECT CAROTID INTERVENT", "code_information": [{"code": "G9689", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT IMPLANT PROS DEV,NO COV", "code_information": [{"code": "C9899", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT30", "code_information": [{"code": "G0425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT50", "code_information": [{"code": "G0426", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT70", "code_information": [{"code": "G0427", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 15", "code_information": [{"code": "G0406", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 25", "code_information": [{"code": "G0407", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 35", "code_information": [{"code": "G0408", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS BONE DEVICE FOR RSA", "code_information": [{"code": "347T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 1ST", "code_information": [{"code": "36245", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 2ND", "code_information": [{"code": "36246", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 3RD", "code_information": [{"code": "36247", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART ADDL", "code_information": [{"code": "36248", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BILAT", "code_information": [{"code": "36252", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNILAT", "code_information": [{"code": "36251", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ BILAT", "code_information": [{"code": "36254", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ UNILAT", "code_information": [{"code": "36253", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS DEVICE FOR RT GUIDE OPEN", "code_information": [{"code": "49412", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37191", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS MARK ABD/PEL FOR RT PERQ", "code_information": [{"code": "49411", "type": "CPT"}], "standard_charges": [{"minimum": 611.27, "maximum": 611.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 611.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS MARK THOR FOR RT PERQ", "code_information": [{"code": "32553", "type": "CPT"}], "standard_charges": [{"minimum": 611.27, "maximum": 611.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 611.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61889", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS TUN IP CATH FOR DIAL OPN", "code_information": [{"code": "49421", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS VAG BRACHYTX DEVICE", "code_information": [{"code": "57156", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS/REP SUBQ DEFIBRILLATOR", "code_information": [{"code": "33270", "type": "CPT"}], "standard_charges": [{"minimum": 79417.32, "maximum": 79417.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 79417.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS/RPL PRPH SAC/GSTR NPG/R", "code_information": [{"code": "64590", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS/RPLC SPI NPG/RCVR POCKET", "code_information": [{"code": "63685", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS/RPLCM PRQ ELTRD RA PN EA", "code_information": [{"code": "64597", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS/RPLCMT PRQ ELTRD RA PN 1", "code_information": [{"code": "64596", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS/RPLMT ELTRD RA SPI NSTIM", "code_information": [{"code": "784T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSEMINATION OF OOCYTES", "code_information": [{"code": "89268", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 369.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 369.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT 1 ELECTRODE PM-DEFIB", "code_information": [{"code": "33216", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT 2 ELECTRODE PM-DEFIB", "code_information": [{"code": "33217", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT ABDOMEN-VENOUS DRAIN", "code_information": [{"code": "49425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT AND REMOVE BONE PIN", "code_information": [{"code": "20650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT ANT DRAINAGE DEVICE", "code_information": [{"code": "66183", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT AQUEOUS DRAIN DEVICE", "code_information": [{"code": "253T", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT BALLOON DEVICE", "code_information": [{"code": "33973", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATH COMPLEX TECH", "code_information": [{"code": "51703", "type": "CPT"}, {"code": "11000069", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 233.1, "maximum": 368.06, "gross_charge": 408.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 306.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 327.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 368.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 233.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BRAIN-FLUID DEVICE", "code_information": [{"code": "61215", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT CARD ELECTRODES DUAL", "code_information": [{"code": "33211", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/ IMAGE", "code_information": [{"code": "32557", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/O IMAGE", "code_information": [{"code": "32556", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT CENTRAL LINE (TECH)", "code_information": [{"code": "36568", "type": "CPT"}, {"code": "11000228", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1344.19, "maximum": 2122.41, "gross_charge": 2358.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1768.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1886.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2122.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1344.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CERVICAL DILATOR", "code_information": [{"code": "59200", "type": "CPT"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT CHEST TUBE", "code_information": [{"code": "32551", "type": "CPT"}, {"code": "11000230", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1680.87, "maximum": 2654.01, "gross_charge": 2948.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2211.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2359.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2654.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1680.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CV CATH INF & SUP APP", "code_information": [{"code": "C9780", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT DRUG DEL IMPLANT, >=4", "code_information": [{"code": "G0516", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRD/PM CATH SNGL", "code_information": [{"code": "33210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRODES FOR EEG", "code_information": [{"code": "95830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT ENDOVASC PROSTH TAA", "code_information": [{"code": "33883", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD ENDO", "code_information": [{"code": "33203", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD OPEN", "code_information": [{"code": "33202", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT EYE SOCKET IMPLANT", "code_information": [{"code": "67550", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM ATRIAL", "code_information": [{"code": "33206", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM VENTRICULAR", "code_information": [{"code": "33207", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT HEPATIC SHUNT (TIPS)", "code_information": [{"code": "37182", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT HEYMAN UTERI CAPSULE", "code_information": [{"code": "58346", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT I-AORT PERCUT DEVICE", "code_information": [{"code": "33967", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT INDWELL BLADDER CATH TECH", "code_information": [{"code": "51702", "type": "CPT"}, {"code": "11000070", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "estimated_discounted_cash": 315.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT INTRACORPOREAL DEVICE", "code_information": [{"code": "33979", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT INTRAUTERINE DEVICE", "code_information": [{"code": "58300", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT LENS PROSTHESIS", "code_information": [{"code": "66985", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT LEVONORGESTREL IUS", "code_information": [{"code": "S4981", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33330", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33335", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT MESH/PELVIC FLR ADDON", "code_information": [{"code": "57267", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT MULTI-COMP PENIS PROS", "code_information": [{"code": "54405", "type": "CPT"}], "standard_charges": [{"minimum": 43844.82, "maximum": 43844.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 43844.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT NASAL SEPTAL BUTTON", "code_information": [{"code": "30220", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE BONE CAVITY", "code_information": [{"code": "36680", "type": "CPT"}], "standard_charges": [{"minimum": 2028.36, "maximum": 2028.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2028.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE CATH BOWEL", "code_information": [{"code": "44015", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36555", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNELED CATH (5 YR & UP)", "code_information": [{"code": "36556", "type": "CPT"}, {"code": "11000299", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 184.16, "maximum": 7010.67, "gross_charge": 323.09, "discounted_cash": 54.17, "estimated_discounted_cash": 323.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 242.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 258.47, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 290.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 184.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65130", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65135", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PACING LEAD & CONNECT", "code_information": [{"code": "33224", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PELV FIXATION DEVICE", "code_information": [{"code": "22848", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36570", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36571", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PLEURAL CATH", "code_information": [{"code": "32550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PROST URETHRAL STENT", "code_information": [{"code": "53855", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN DUAL LEADS", "code_information": [{"code": "33213", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN MULT LEADS", "code_information": [{"code": "33221", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN SNGL LEAD", "code_information": [{"code": "33212", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SELF-CONTD PROSTHESIS", "code_information": [{"code": "54401", "type": "CPT"}], "standard_charges": [{"minimum": 43844.82, "maximum": 43844.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 43844.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SEMI-RIGID PROSTHESIS", "code_information": [{"code": "54400", "type": "CPT"}], "standard_charges": [{"minimum": 43844.82, "maximum": 43844.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 43844.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22841", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22842", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22843", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22844", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22846", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22847", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE INFUSION DEVICE", "code_information": [{"code": "62360", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SUBQ EXTEN TO IP CATH", "code_information": [{"code": "49435", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TANDEM CUFF", "code_information": [{"code": "53444", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TISSUE EXPANDER(S)", "code_information": [{"code": "11960", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH PERC", "code_information": [{"code": "49418", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH W/PORT", "code_information": [{"code": "49419", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36557", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36558", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36560", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36561", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36563", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36565", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36566", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT URETERAL SUPPORT", "code_information": [{"code": "50605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT URO/VES NCK SPHINCTER", "code_information": [{"code": "53445", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT UTERI TANDEM/OVOIDS", "code_information": [{"code": "57155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT/PLACE HEART CATHETER", "code_information": [{"code": "93503", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36620", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36625", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36640", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION DRUG DLVR IMPLANT", "code_information": [{"code": "11981", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36800", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36810", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36815", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA(S)", "code_information": [{"code": "36823", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36481", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INFUSION PUMP", "code_information": [{"code": "36260", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF LEFT HEART VENT", "code_information": [{"code": "33988", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION PALATE PROSTHESIS", "code_information": [{"code": "42281", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION SS DFB ELECTRODE", "code_information": [{"code": "572T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88364", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 146.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 146.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88365", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 190.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 190.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88366", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 301.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 301.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION AUTO", "code_information": [{"code": "88367", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 120.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION MANUAL", "code_information": [{"code": "88368", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 144.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 144.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ ANT SGM AQ DRG DEV 1+", "code_information": [{"code": "671T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV 1ST", "code_information": [{"code": "449T", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV EACH", "code_information": [{"code": "450T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRG DEV IO RSVR", "code_information": [{"code": "474T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22853", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22854", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22859", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ BIOPROSTC VLV FEM VN", "code_information": [{"code": "744T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ BREAST IMPLT SM D MAST", "code_information": [{"code": "19340", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ GTUBE PERQ MAG GASTRPXY", "code_information": [{"code": "647T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "446T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ OCULAR TELESCOPE PROSTH", "code_information": [{"code": "308T", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTERIAL", "code_information": [{"code": "33990", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTL&VEN", "code_information": [{"code": "33991", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD R HRT VENOUS", "code_information": [{"code": "33995", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM SYS", "code_information": [{"code": "33276", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33277", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PICC 5 YR+ W/O IMAGING", "code_information": [{"code": "36569", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I 5 YR+", "code_information": [{"code": "36573", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I <5 YR", "code_information": [{"code": "36572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ RX ELUT IMPLT LAC CANAL", "code_information": [{"code": "68841", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ SINUS TARSI IMPLANT", "code_information": [{"code": "335T", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22867", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22868", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22869", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22870", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ IMPLTBL DFB ELCTRD", "code_information": [{"code": "33271", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV BOTH COMPNT PG", "code_information": [{"code": "517T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV COMPL SYS", "code_information": [{"code": "515T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV ELTRD ONLY", "code_information": [{"code": "516T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ ATR ELT", "code_information": [{"code": "410T", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ PLS GN", "code_information": [{"code": "409T", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ VNT ELT", "code_information": [{"code": "411T", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CARDIAC MODULJ SYS", "code_information": [{"code": "408T", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT BRST IMPLT SEP D", "code_information": [{"code": "19342", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT COMPL IIMS", "code_information": [{"code": "525T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT DEFIB W/LEAD(S)", "code_information": [{"code": "33249", "type": "CPT"}], "standard_charges": [{"minimum": 79417.32, "maximum": 79417.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 79417.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT ICDS SS ELTRD", "code_information": [{"code": "571T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS ELTRD ONLY", "code_information": [{"code": "526T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS IMPLT MNTR", "code_information": [{"code": "527T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PG ONLY ISDSS", "code_information": [{"code": "680T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PRQ RA SAC NSTIM", "code_information": [{"code": "786T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT A & V PM W/L VENT LEAD", "code_information": [{"code": "C7539", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT ATRIL PM W/L VENT LEAD", "code_information": [{"code": "C7537", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT HEART PM ATRIAL & VENT", "code_information": [{"code": "33208", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/DUAL LEADS", "code_information": [{"code": "33230", "type": "CPT"}], "standard_charges": [{"minimum": 79417.32, "maximum": 79417.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 79417.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/MULT LEADS", "code_information": [{"code": "33231", "type": "CPT"}], "standard_charges": [{"minimum": 79417.32, "maximum": 79417.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 79417.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/SINGL LEAD", "code_information": [{"code": "33240", "type": "CPT"}], "standard_charges": [{"minimum": 79417.32, "maximum": 79417.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 79417.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT VENT PM W/L VENT LEAD", "code_information": [{"code": "C7538", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSRT/REDO NEUROSTIM 1 ARRAY", "code_information": [{"code": "61885", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63741", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTI HEXAMINOLEVULINATE HCL", "code_information": [{"code": "A9589", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTILL ADSTILADRIN, TX DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTILL PHARM RENAL PELVIS", "code_information": [{"code": "C9789", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTILL, BUPIVAC AND MELOXIC", "code_information": [{"code": "C9088", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTLJ FECAL MICROBIOTA SSP", "code_information": [{"code": "780T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTLL RX AGNT INTO RNAL TUB", "code_information": [{"code": "50391", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTR XRCZ BACK PAIN 12 WKS", "code_information": [{"code": "4240F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN", "code_information": [{"code": "83525", "type": "CPT"}, {"code": "1099025", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.14, "maximum": 73.8, "gross_charge": 82.0, "discounted_cash": 54.17, "estimated_discounted_cash": 82.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 73.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN ANTIBODY", "code_information": [{"code": "86337", "type": "CPT"}, {"code": "1000252", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.62, "maximum": 114.07, "gross_charge": 126.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 101.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 114.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 72.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN CARTRIDGE 150 U", "code_information": [{"code": "S5565", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN CARTRIDGE 300 U", "code_information": [{"code": "S5566", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN DISPOS PEN 1.5 ML", "code_information": [{"code": "S5570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN DISPOS PEN 3 ML", "code_information": [{"code": "S5571", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN HUMALOG 100 UNITS/ML", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "72000142", "type": "CDM"}, {"code": "00002751001", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN HUMALOG 75/25 100 UNITS/ML", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "72000585", "type": "CDM"}, {"code": "00002751101", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN HUMALOG PEN 100U/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001044", "type": "CDM"}, {"code": "00002879959", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSULIN HUMULIN 70/30 100 UNITS/ML", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "7000226", "type": "CDM"}, {"code": "00002871501", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN HUMULIN N 100 UNITS/ML", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J1817", "type": "HCPCS"}, {"code": "7000227", "type": "CDM"}, {"code": "50090035200", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN HUMULIN R 100U/ML/100ML 0.9% NS", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "72001092", "type": "CDM"}, {"code": "00002821517", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN HUMULIN R INSULIN 100UNITS/ML", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "7000228", "type": "CDM"}, {"code": "00169183311", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN INTERMED 5 U", "code_information": [{"code": "S5552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN LANTUS 100 UNITS/ML", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "7000269", "type": "CDM"}, {"code": "00088222033", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN LEVEMIR 100 UNITS/ML", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "72000344", "type": "CDM"}, {"code": "00169368712", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSULIN LIKE GROWTH FACTOR-1 (IGF-1)", "code_information": [{"code": "84305", "type": "CPT"}, {"code": "1000737", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 24.45, "maximum": 107.24, "gross_charge": 119.16, "discounted_cash": 54.17, "estimated_discounted_cash": 119.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 95.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 107.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 67.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN LONG ACTING 5 U", "code_information": [{"code": "S5553", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN MOST RAPID 5 U", "code_information": [{"code": "S5551", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN NOVOLIN R 100U/ML", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "72001051", "type": "CDM"}, {"code": "00169183311", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSULIN NOVOLOG 100U/ML", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "72000381", "type": "CDM"}, {"code": "73070010011", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN PUMP INITIATION", "code_information": [{"code": "S9145", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN RAPID 5 U", "code_information": [{"code": "S5550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN REUSE PEN 1.5 ML", "code_information": [{"code": "S5560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN REUSE PEN 3 ML", "code_information": [{"code": "S5561", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN SUPPRESSION PANEL", "code_information": [{"code": "80432", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 190.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 190.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80434", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 327.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 327.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80435", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 118.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 118.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INT CARIES MED APP PER TOOTH", "code_information": [{"code": "D1354", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INT FLUSH (SOD CHLOR) INJ 0.9% 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000185", "type": "CDM"}, {"code": "64253011130", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INT HRHC LIG 1 HROID W/O IMG", "code_information": [{"code": "46945", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 2+HROID W/O IMG", "code_information": [{"code": "46946", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INT HRHC TRANAL DARTLZJ 2+", "code_information": [{"code": "46948", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INT MAM ART USED FOR CABG", "code_information": [{"code": "4110F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INT PLUG HEPLOCK", "code_information": [{"code": "3000501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INT/ABUT INT FIXED DENT MAX", "code_information": [{"code": "D6119", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTAKE ACT W/MED EXAM", "code_information": [{"code": "G2076", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRA BMWD", "code_information": [{"code": "Q4104", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRA DRT OR OMNIGRAFT", "code_information": [{"code": "Q4105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRA FLOWABLE WOUND MATRI", "code_information": [{"code": "Q4114", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRA MATRIX", "code_information": [{"code": "Q4108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRA MESHED BIL WOUND MAT", "code_information": [{"code": "C9363", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRATED KERATOPROSTHESIS", "code_information": [{"code": "C1818", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRILIN (EPTIFIBATIDE) 2MG/ML INJ", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J1327", "type": "HCPCS"}, {"code": "7000248", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 152.41, "maximum": 1601.71, "gross_charge": 267.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 200.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 213.92, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 240.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 152.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRILIN 0.75MG/ML INJ 100ML", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J1327", "type": "HCPCS"}, {"code": "7000249", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 477.17, "maximum": 1601.71, "gross_charge": 837.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 627.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 669.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 753.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 477.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEN OUTPT SVS,MIN 9 PR 7 D", "code_information": [{"code": "G0137", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTENS BEHAVE THER CARDIO DX", "code_information": [{"code": "G0446", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB NO EXER", "code_information": [{"code": "G0423", "type": "HCPCS"}], "standard_charges": [{"minimum": 478.72, "maximum": 478.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 478.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB W/EXERC", "code_information": [{"code": "G0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 478.72, "maximum": 478.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 478.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTENSIVE OUTPATIENT PSYCHIA", "code_information": [{"code": "S9480", "type": "HCPCS"}], "standard_charges": [{"minimum": 925.4, "maximum": 925.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 925.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTENT POT REMV TIME PLACEMT", "code_information": [{"code": "G9539", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTENTIONAL REPLANTATION", "code_information": [{"code": "D3470", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTER LIMB COMPRESS DEV NOS", "code_information": [{"code": "E0676", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERACTIVE GRP PSYC PHP/IOP", "code_information": [{"code": "G0411", "type": "HCPCS"}], "standard_charges": [{"minimum": 683.18, "maximum": 683.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 683.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERCALARY ALGRFT COMPL", "code_information": [{"code": "20934", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL FIXATION", "code_information": [{"code": "21110", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL WIRING", "code_information": [{"code": "21497", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERDISCAL PERQ ASPIR DX", "code_information": [{"code": "62267", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERDRY AG DRSG 10 X 144", "code_information": [{"code": "3001416", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 262.59, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INTEREST ESCORT IN NON ER", "code_information": [{"code": "A0090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERENTIAL STIM 2 CHAN", "code_information": [{"code": "S8130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERENTIAL STIM 4 CHAN", "code_information": [{"code": "S8131", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-2A INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9213", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-2B INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9214", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.3, "maximum": 631.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-N3 INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFACON-1 INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON BETA-1A INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1826", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON BETA-1B / .25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1830", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON GAMMA 1-B INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9216", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFYL, 1 MG", "code_information": [{"code": "Q4171", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERIM CROWN", "code_information": [{"code": "D2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERIM IMPLANT ABUTMENT", "code_information": [{"code": "D6051", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERIM IMPLANT CROWN", "code_information": [{"code": "D6085", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERIM LABOR FACILITY GLOBA", "code_information": [{"code": "S4005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERIM PONTIC", "code_information": [{"code": "D6253", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERIM RETAINER CROWN", "code_information": [{"code": "D6793", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERMEDIATE VISUAL FIELD XM", "code_information": [{"code": "92082", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERMITTENT ASTHMA", "code_information": [{"code": "1039F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERNAL MEDICINE SS", "code_information": [{"code": "G4011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERNAL NERVE REVISION", "code_information": [{"code": "64727", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERNAL ROOT REPAIR", "code_information": [{"code": "D3333", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERRO EVAL CARDIAC MODULJ", "code_information": [{"code": "418T", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICDS SS IP", "code_information": [{"code": "576T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICPMS IP", "code_information": [{"code": "93290", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL IIMS IP", "code_information": [{"code": "529T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ISDSS IP", "code_information": [{"code": "685T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL SCRMS IP", "code_information": [{"code": "93291", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL WCS IP", "code_information": [{"code": "521T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEVICE EVAL HEART", "code_information": [{"code": "93289", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG EVL PM/LDLS PM IP", "code_information": [{"code": "93288", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG W/O PRGRMG IPNSS", "code_information": [{"code": "93153", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS", "code_information": [{"code": "93151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS POLYSM", "code_information": [{"code": "93152", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS DEV", "code_information": [{"code": "272T", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS W/PGRMG", "code_information": [{"code": "273T", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROGATE SUBQ DEFIB", "code_information": [{"code": "93261", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROGATION VAD IN PERSON", "code_information": [{"code": "93750", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERSPINOUS IMPLANT", "code_information": [{"code": "C1821", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [{"code": "197", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [{"code": "196", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [{"code": "198", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTERTHORACOSCPLR AMPUTATION", "code_information": [{"code": "23900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERV REQ FOR LEAK", "code_information": [{"code": "G9306", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERVENTIONAL RAD SS", "code_information": [{"code": "G4012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTESTINAL STRICTUROPLASTY", "code_information": [{"code": "44615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLANT LIVE", "code_information": [{"code": "44136", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLNT CADAVER", "code_information": [{"code": "44135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL PACING", "code_information": [{"code": "93610", "type": "CPT"}], "standard_charges": [{"minimum": 19778.37, "maximum": 19778.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19778.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL RECORDING", "code_information": [{"code": "93602", "type": "CPT"}], "standard_charges": [{"minimum": 19778.37, "maximum": 19778.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19778.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAABDOMINAL PRESSURE TEST", "code_information": [{"code": "51797", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACARDIAC ECG (ICE)", "code_information": [{"code": "93662", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRAN ANGIOPLSTY W/STENT", "code_information": [{"code": "61635", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL ANGIOPLASTY", "code_information": [{"code": "61630", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL COMPLETE STUDY", "code_information": [{"code": "93886", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [{"code": "65", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [{"code": "64", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC", "code_information": [{"code": "66", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL LIMITED STUDY", "code_information": [{"code": "93888", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [{"code": "21", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [{"code": "20", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "22", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61680", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61682", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61684", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61686", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61690", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61692", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAFRACTION TRACK MOTION", "code_information": [{"code": "G6017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAGASTRIC HYPOTHERMIA", "code_information": [{"code": "M0100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRANASAL BIOPSY", "code_information": [{"code": "30100", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRANASAL RECONSTRUCTION", "code_information": [{"code": "30620", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR FOMIVIRSEN NA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1452", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [{"code": "116", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "117", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "INTRAOP COLON LAVAGE ADD-ON", "code_information": [{"code": "44701", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOP CYST EVAL NOT DONE", "code_information": [{"code": "G9608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOP CYST EVAL TRAC INJ", "code_information": [{"code": "G9606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOP HIPEC PX 1ST 60 MIN", "code_information": [{"code": "96547", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BREAST CAVITY", "code_information": [{"code": "353T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BRST/NODE SPEC", "code_information": [{"code": "351T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOR COMPREHENSIVE SERIES", "code_information": [{"code": "D0210", "type": "HCPCS"}], "standard_charges": [{"minimum": 377.64, "maximum": 377.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 377.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL BITE RADIO IMAGE", "code_information": [{"code": "D0708", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL COMP IMAGE CAPTURE", "code_information": [{"code": "D0709", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL CON DEF INTER PLT", "code_information": [{"code": "D5958", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL CON DEF MOD PALAT", "code_information": [{"code": "D5959", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL OCCLUS RADIO IMAGE", "code_information": [{"code": "D0706", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL OCCLUSAL FILM", "code_information": [{"code": "D0240", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PERIAP RADIO IMAGE", "code_information": [{"code": "D0707", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PERIAPICAL EA ADD", "code_information": [{"code": "D0230", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PERIAPICAL FIRST", "code_information": [{"code": "D0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PLACE OF FIX DEV", "code_information": [{"code": "D7998", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAORIFICE BARRIER", "code_information": [{"code": "D3911", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRATUBAL OCCLUSION DEVICE", "code_information": [{"code": "A4264", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAUT COPPER CONTRACEPTIVE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAUTERINE TRANSFUSION FTL", "code_information": [{"code": "36460", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAVENTRICULAR PACING", "code_information": [{"code": "93612", "type": "CPT"}], "standard_charges": [{"minimum": 19778.37, "maximum": 19778.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19778.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAVERTEBRAL FX AUG IMPL", "code_information": [{"code": "C1062", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRINSIC FACTOR BLOCKING ANTIBODIES", "code_information": [{"code": "86340", "type": "CPT"}, {"code": "1000340", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.34, "maximum": 103.37, "gross_charge": 89.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 71.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 80.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM EST PATIENT", "code_information": [{"code": "92012", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM NEW PATIENT", "code_information": [{"code": "92002", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRMED RSK THROMBOEMBOLISM", "code_information": [{"code": "3551F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRNL BLEACHING PER TOOTH", "code_information": [{"code": "D9974", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36901", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36902", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36903", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO GASTROINTESTINAL TUBE", "code_information": [{"code": "44500", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO NDL ICATH UPR/LXTR ART", "code_information": [{"code": "36140", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO WINDPIPE WIRE/TUBE", "code_information": [{"code": "31730", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO/SHEATH, FIXED,NON-PEEL", "code_information": [{"code": "C1893", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO/SHEATH, LASER", "code_information": [{"code": "C2629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO/SHEATH, NON-LASER", "code_information": [{"code": "C1894", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO/SHEATH,FIXED,PEEL-AWAY", "code_information": [{"code": "C1892", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRO/SHEATH,STRBLE,NON-PEEL", "code_information": [{"code": "C1766", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTROPIN (DOPAMINE HCL) 400MG/250ML D5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200077", "type": "CDM"}, {"code": "00338100702", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 19.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INTRPULMNRY PERCUSS VENT SYS", "code_information": [{"code": "E0481", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY 1ST", "code_information": [{"code": "37252", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY ADDL", "code_information": [{"code": "37253", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRVL 3/>YR PTS CLNSCP DOCD", "code_information": [{"code": "529F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INVANZ 1GM", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J1335", "type": "HCPCS"}, {"code": "7200093", "type": "CDM"}, {"code": "60505619604", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 31.63, "maximum": 49.95, "gross_charge": 55.5, "discounted_cash": 54.17, "estimated_discounted_cash": 111.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INVANZ 1GM/0.9% NS 100ML IVPB", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J1335", "type": "HCPCS"}, {"code": "72001142", "type": "CDM"}, {"code": "60505619604", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 37.23, "maximum": 58.79, "gross_charge": 65.33, "discounted_cash": 54.17, "estimated_discounted_cash": 111.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 58.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INVERSION EVERSION COR DEVIC", "code_information": [{"code": "A9285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM INIT", "code_information": [{"code": "95980", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM SUBSQ", "code_information": [{"code": "95981", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IO GA N-STIM SUBSQ W/REPROG", "code_information": [{"code": "95982", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IO MAP OF SENT LYMPH NODE", "code_information": [{"code": "38900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVER BY ELCTRNS", "code_information": [{"code": "77425", "type": "CPT"}], "standard_charges": [{"minimum": 260.01, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 260.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVERY BY X-RAY", "code_information": [{"code": "77424", "type": "CPT"}], "standard_charges": [{"minimum": 368.46, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 368.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IO RADIATION TX MANAGEMENT", "code_information": [{"code": "77469", "type": "CPT"}], "standard_charges": [{"minimum": 536.89, "maximum": 1008.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 536.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 IOBENGUANE", "code_information": [{"code": "A9582", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 IOFLUPANE", "code_information": [{"code": "A9584", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 SOD IODIDE MIC", "code_information": [{"code": "A9516", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 SOD IODIDE MIL", "code_information": [{"code": "A9509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-125 SODIUM IODIDE", "code_information": [{"code": "A9527", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-131 IOBENGUANE 1MCI", "code_information": [{"code": "A9590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-131 IODIDE CAP, DX", "code_information": [{"code": "A9528", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODOFORM PACKING STRIP 1", "code_information": [{"code": "3000193", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IODOFORM PACKING STRIP 1/4", "code_information": [{"code": "3001259", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IONM IN OPERATNG ROOM 15 MIN", "code_information": [{"code": "95940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IONM REMOTE/>1 PT OR PER HR", "code_information": [{"code": "95941", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IOP DEC <20% FROM BASE", "code_information": [{"code": "M1224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IOP DEC>=20% FROM BASE", "code_information": [{"code": "M1225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IOP DOWN <15% OF PRE-SVC LVL", "code_information": [{"code": "3285F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IOP NOT DOC", "code_information": [{"code": "M1226", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IOP RED >=15% PRE-NTRV LVL", "code_information": [{"code": "3284F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST LOW 45", "code_information": [{"code": "99253", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST MOD 60", "code_information": [{"code": "99254", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST HI 80", "code_information": [{"code": "99255", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST SF 35", "code_information": [{"code": "99252", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IPILIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9228", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE 0.03% NSL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001089", "type": "CDM"}, {"code": "60505082601", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE 0.03% NSL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004321", "type": "CDM"}, {"code": "60505082601", "type": "NDC"}], "standard_charges": [{"gross_charge": 6.92, "setting": "both", "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7645", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7644", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRBESARTAN (AVAPRO) TABLET 150MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000055", "type": "CDM"}, {"code": "66105050303", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUM ORGAN PERQ", "code_information": [{"code": "600T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUMORS OPEN", "code_information": [{"code": "601T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRINOTECAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9206", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRIS PROSTHESIS", "code_information": [{"code": "C1839", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRON", "code_information": [{"code": "83540", "type": "CPT"}, {"code": "1000674", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.44, "maximum": 34.5, "gross_charge": 38.34, "discounted_cash": 54.17, "estimated_discounted_cash": 41.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 30.67, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRON STAIN PERIPHERAL BLOOD", "code_information": [{"code": "85536", "type": "CPT"}], "standard_charges": [{"minimum": 7.91, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRON/ TIBC", "code_information": [{"code": "83540", "type": "CPT"}, {"code": "1000175", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.44, "maximum": 34.5, "gross_charge": 38.34, "discounted_cash": 54.17, "estimated_discounted_cash": 41.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 30.67, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATION IMPLANTED VENOUS ACCESS DEVIC", "code_information": [{"code": "96523", "type": "CPT"}, {"code": "11000293", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 33.01, "maximum": 151.2, "gross_charge": 168.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 151.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 95.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATION MAXILLARY SINUS", "code_information": [{"code": "31000", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRRIGATION OF BLADDER", "code_information": [{"code": "51700", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRRIGATION SPHENOID SINUS", "code_information": [{"code": "31002", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IRRIGATION SYRINGE 60CC", "code_information": [{"code": "3001412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IRRIGATION TUBING SET CYSTO/TUR", "code_information": [{"code": "3001121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IRRIGATION W/PISTON SET", "code_information": [{"code": "3000502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.37, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ISA NOT RED 3PTS /NO ASSESS", "code_information": [{"code": "M1198", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISA NOT RED 3PTS/NO ASSESS", "code_information": [{"code": "M1206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISA REDUCED >=3", "code_information": [{"code": "M1205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISA REDUCED >=3 FR IXV", "code_information": [{"code": "M1197", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [{"code": "62", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [{"code": "61", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC", "code_information": [{"code": "63", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ISCHM STROKE SX ONSET>=3HR", "code_information": [{"code": "1066F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISCHM STROKE SYMP LT3 HRSB/4", "code_information": [{"code": "1065F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISLAND PEDICLE FLAP GRAFT", "code_information": [{"code": "15740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISLET CELL TISSUE TRANSPLANT", "code_information": [{"code": "S2102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7647", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7648", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7649", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOLATION STETHOSCOPE", "code_information": [{"code": "3000216", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ISOLATION- TOOTH W RUBB DAM", "code_information": [{"code": "D3910", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7657", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7658", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7659", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISORDIL (ISOSORBIDE DINITRATE) 20MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001996", "type": "CDM"}, {"code": "50268044915", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ISORDIL (ISOSORBIDE DINITRATE) 30MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001329", "type": "CDM"}, {"code": "49884000901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ISORDIL (ISOSORBIDE DINITRATE) 5MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004302", "type": "CDM"}, {"code": "00143176901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ISORDIL (ISOSORBIDE DINITRATE) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004319", "type": "CDM"}, {"code": "50268044915", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ISORDIL (ISOSORBIDE DINITRATE)TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000252", "type": "CDM"}, {"code": "00904661961", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ITRACONAZOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1835", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IV 10GTTS/ML DUO-VENT IV SET", "code_information": [{"code": "3001310", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV 60GTTS/ML IV SET", "code_information": [{"code": "3001319", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV 60GTTS/ML VENTED IV SET", "code_information": [{"code": "3001410", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV BURETROL INTERLINK", "code_information": [{"code": "3000217", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 27.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CAP INTERMITTENT INJ", "code_information": [{"code": "Q0081", "type": "HCPCS"}, {"code": "3000506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1.51, "maximum": 966.98, "gross_charge": 2.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV CATH BUTTERFLY 21GA", "code_information": [{"code": "3000422", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATH PORT A 20GA(GRIPPER)X 1", "code_information": [{"code": "3001289", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATH PORT A GRIPPER 20GA X 3/4", "code_information": [{"code": "3000455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATH TWO LUMEN 18GA", "code_information": [{"code": "3001375", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 28.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATHETER 16GA", "code_information": [{"code": "3001316", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATHETER 18GA", "code_information": [{"code": "3001315", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATHETER 20GA", "code_information": [{"code": "3001313", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATHETER 22GA", "code_information": [{"code": "3001314", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATHETER 23G X 3/4", "code_information": [{"code": "3001459", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATHETER 24G X 0.5", "code_information": [{"code": "3001450", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATHETER 24GA", "code_information": [{"code": "3001317", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CATHETER 25G X 3/4", "code_information": [{"code": "3001458", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CHELATIONTHERAPY", "code_information": [{"code": "M0300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IV CONTINU-FLOW FILTER", "code_information": [{"code": "3000509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV CURO PORT PROTECTOR (LONG)", "code_information": [{"code": "Q0081", "type": "HCPCS"}, {"code": "3001455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1.51, "maximum": 966.98, "gross_charge": 2.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV CURO PORT PROTECTOR (SHORT)", "code_information": [{"code": "Q0081", "type": "HCPCS"}, {"code": "3001454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1.51, "maximum": 966.98, "gross_charge": 2.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV DIAL-A-FLOW EXT. SET", "code_information": [{"code": "3000508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV EXTENSION SET", "code_information": [{"code": "3000510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV EXTENSION SET PEDIATRIC", "code_information": [{"code": "3001006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV HEPLOCK EXTENSION SET", "code_information": [{"code": "3001318", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV INFUS ADDL THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96366", "type": "CPT"}, {"code": "11000240", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 63.32, "maximum": 1636.8, "gross_charge": 111.09, "discounted_cash": 54.17, "estimated_discounted_cash": 231.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 83.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 63.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUS ADDL THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96366", "type": "CPT"}, {"code": "11000278", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 63.32, "maximum": 1636.8, "gross_charge": 111.09, "discounted_cash": 54.17, "estimated_discounted_cash": 231.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 83.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 63.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUS CONC THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96368", "type": "CPT"}, {"code": "11000242", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 33.06, "maximum": 966.98, "gross_charge": 58.0, "discounted_cash": 54.17, "estimated_discounted_cash": 58.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 52.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 33.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUS CONC THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96368", "type": "CPT"}, {"code": "11000280", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 33.06, "maximum": 966.98, "gross_charge": 58.0, "discounted_cash": 54.17, "estimated_discounted_cash": 58.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 52.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 33.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUS SEQ THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "11000241", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 966.98, "gross_charge": 174.6, "discounted_cash": 54.17, "estimated_discounted_cash": 206.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUS SEQ THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "11000279", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 966.98, "gross_charge": 174.6, "discounted_cash": 54.17, "estimated_discounted_cash": 206.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUSION 1ST BAG (HYDRATION)", "code_information": [{"code": "96360", "type": "CPT"}, {"code": "11000233", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 326.76, "maximum": 966.98, "gross_charge": 573.27, "discounted_cash": 54.17, "estimated_discounted_cash": 573.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 429.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 458.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 515.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 326.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUSION 1ST BAG (HYDRATION)", "code_information": [{"code": "96360", "type": "CPT"}, {"code": "11000276", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 326.76, "maximum": 966.98, "gross_charge": 573.27, "discounted_cash": 54.17, "estimated_discounted_cash": 573.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 429.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 458.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 515.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 326.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUSION EA ADDL HOUR (HYDRATION)", "code_information": [{"code": "96361", "type": "CPT"}, {"code": "11000234", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 63.32, "maximum": 1636.8, "gross_charge": 111.09, "discounted_cash": 54.17, "estimated_discounted_cash": 523.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 83.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 63.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUSION EA ADDL HOUR (HYDRATION)", "code_information": [{"code": "96361", "type": "CPT"}, {"code": "11000283", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 63.32, "maximum": 1636.8, "gross_charge": 111.09, "discounted_cash": 54.17, "estimated_discounted_cash": 523.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 83.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 63.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUSION, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96365", "type": "CPT"}, {"code": "11000239", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 326.76, "maximum": 966.98, "gross_charge": 573.27, "discounted_cash": 54.17, "estimated_discounted_cash": 571.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 429.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 458.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 515.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 326.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUSION, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96365", "type": "CPT"}, {"code": "11000275", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 326.76, "maximum": 966.98, "gross_charge": 573.27, "discounted_cash": 54.17, "estimated_discounted_cash": 571.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 429.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 458.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 515.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 326.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INJ ADDL, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "11000236", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 72.39, "maximum": 114.3, "gross_charge": 127.0, "discounted_cash": 54.17, "estimated_discounted_cash": 205.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 101.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 114.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INJ ADDL, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "11000282", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 72.39, "maximum": 114.3, "gross_charge": 127.0, "discounted_cash": 54.17, "estimated_discounted_cash": 205.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 101.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 114.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INJ RA DRUG DX STUDY", "code_information": [{"code": "78808", "type": "CPT"}], "standard_charges": [{"minimum": 50.34, "maximum": 50.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IV INJ UNLIS, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96379", "type": "CPT"}, {"code": "11000237", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 63.32, "maximum": 99.98, "gross_charge": 111.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 83.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 63.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INJECTION, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "11000235", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 326.76, "maximum": 515.94, "gross_charge": 573.27, "discounted_cash": 54.17, "estimated_discounted_cash": 570.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 429.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 458.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 515.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 326.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INJECTION, THERA, PROPHYL OR DIAGNOST", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "11000277", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 326.76, "maximum": 515.94, "gross_charge": 573.27, "discounted_cash": 54.17, "estimated_discounted_cash": 570.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 429.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 458.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 515.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 326.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV MED PUSH,EA SAME MED 30 MIN APART", "code_information": [{"code": "96376", "type": "CPT"}, {"code": "11000244", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 68.4, "maximum": 108.0, "gross_charge": 120.0, "discounted_cash": 54.17, "estimated_discounted_cash": 178.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV MED PUSH,EA SAME MED 30 MIN APART", "code_information": [{"code": "96376", "type": "CPT"}, {"code": "11000281", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 68.4, "maximum": 108.0, "gross_charge": 120.0, "discounted_cash": 54.17, "estimated_discounted_cash": 178.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV MINI-FLOW FILTER", "code_information": [{"code": "3000512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV MOD SEDATION, 1ST 15 MIN", "code_information": [{"code": "D9239", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.72, "maximum": 112.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IV NITROGLYCERIN SET", "code_information": [{"code": "3000513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV PUMP PER 24HOURS", "code_information": [{"code": "3000028", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV SECONDARY", "code_information": [{"code": "3000514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV SEDATION EA ADDL 15M", "code_information": [{"code": "D9243", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.72, "maximum": 112.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IV START KIT, CHLORAPREP AMPUEL", "code_information": [{"code": "3001339", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IV TUBING EXTENSION SET", "code_information": [{"code": "S1015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IV Y-TYPE BLOOD SET 10GTTS/ML", "code_information": [{"code": "3001311", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.18, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "IVF CANC A ASPIR CASE RATE", "code_information": [{"code": "S4020", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IVF CANC A STIM CASE RATE", "code_information": [{"code": "S4017", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IVF CANC P ASPIR CASE RATE", "code_information": [{"code": "S4021", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IVF PACKAGE", "code_information": [{"code": "S4011", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IVIG NON-LYOPHILIZED, NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1599", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IVP CONTRAST (OPTIRAY)", "code_information": [{"code": "Q9967", "type": "HCPCS"}, {"code": "2000001", "type": "CDM"}, {"code": "259", "type": "RC"}], "standard_charges": [{"minimum": 106.22, "maximum": 167.72, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 139.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IXABEPILONE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9207", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IXV NRS VRS IQA >=4", "code_information": [{"code": "M1196", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IXV NRS VRS IQA >=4", "code_information": [{"code": "M1204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IgG, Qn SERUM", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "1000815", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.7, "maximum": 49.54, "gross_charge": 55.05, "discounted_cash": 54.17, "estimated_discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IgM, Qn SERUM", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "1000814", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.7, "maximum": 49.54, "gross_charge": 55.05, "discounted_cash": 54.17, "estimated_discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers", "code_information": [{"code": "L6037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Implantation of iris prosthesis, including suture fixation and repair or removal of iris, when performed", "code_information": [{"code": "66683", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (eg, fluoroscopy)", "code_information": [{"code": "C8003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Implantation of subcutaneous peritoneal ascites pump system, percutaneous, including pump-pocket creation, insertion of tunneled indwelling bladder and peritoneal catheters with pump connections, including all imaging and initial programming, when perform", "code_information": [{"code": "870T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; dual arch, with additional mandibular advancement, fixed hinge mechanism", "code_information": [{"code": "966T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; dual arch, with additional mandibular advancement, non-fixed hinge mechanism", "code_information": [{"code": "965T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; single arch, without mandibular advancement mechanism", "code_information": [{"code": "964T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "In-home respite care, 4-hour unit, for use in CMMI model", "code_information": [{"code": "G0529", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Helicobacter pylori (H. pylori), clarithromycin resistance, amplified probe technique", "code_information": [{"code": "87513", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 40.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Hepatitis C, screening, amplified probe technique", "code_information": [{"code": "G0567", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), separately reported high-risk types (eg, 16, 18, 31, 45, 51, 52) and high-risk pooled result(s)", "code_information": [{"code": "87626", "type": "CPT"}], "standard_charges": [{"minimum": 80.73, "maximum": 80.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 80.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Mycobacterium tuberculosis, rifampin resistance, amplified probe technique", "code_information": [{"code": "87564", "type": "CPT"}], "standard_charges": [{"minimum": 88.29, "maximum": 88.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 88.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious agent detection by nucleic acid (DNA or RNA); Pneumocystis jirovecii, amplified probe technique", "code_information": [{"code": "87594", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 40.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious agents (sexually transmitted infection), Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, multiplex amplified probe technique, vaginal, endocervical, gynecological specimens, oropharyngeal swabs, rectal swabs, female or ", "code_information": [{"code": "455U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (Mycoplasma genitalium), macrolide sensitivity (23S rRNA point mutation), oral, rectal, or vaginal swab, algorithm reported as probability of macrolide resistance", "code_information": [{"code": "484U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (Neisseria gonorrhoeae), sensitivity, ciprofloxacin resistance (gyrA S91F point mutation), oral, rectal, or vaginal swab, algorithm reported as probability of fluoroquinolone resistance", "code_information": [{"code": "483U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (acid-fast bacteria and invasive fungi), DNA (673 organisms), next-generation sequencing, plasma", "code_information": [{"code": "531U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacteria, viruses, fungi, and parasites), cerebrospinal fluid (CSF), metagenomic next-generation sequencing (DNA and RNA), bioinformatic analysis, with positive pathogen identification", "code_information": [{"code": "480U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial and/or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 10 viral targets and 4 bacterial targets, qualitative RT-PCR, upper respiratory specimen, each pathogen reported as positive or negative", "code_information": [{"code": "564U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial and/or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 11 viral targets and 4 bacterial targets, qualitative RT-PCR, upper respiratory specimen, each pathogen reported as positive or negative", "code_information": [{"code": "563U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific DNA and RNA by real-time PCR, 12 targets, nasopharyngeal or oropharyngeal swab, including multiplex reverse transcription for RNA targets, each analyte reported as dete", "code_information": [{"code": "556U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial vaginosis and vaginitis), real-time amplification of DNA markers for Atopobium vaginae, Gardnerella vaginalis, Megasphaera types 1 and 2, bacterial vaginosis associated bacteria-2 and -3 (BVAB-2, BVAB-3), Mobiluncus species, ", "code_information": [{"code": "557U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (bacterial, fungal, or viral infection), semiquantitative biomechanical assessment (via deformability cytometry), whole blood, with algorithmic analysis and result reported as an index", "code_information": [{"code": "441U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (respiratory infection), Myxovirus resistance protein A (MxA) and C-reactive protein (CRP), fingerstick whole blood specimen, each biomarker reported as present or absent", "code_information": [{"code": "442U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (urinary tract infection), identification of 17 pathologic organisms, urine, real-time PCR, reported as positive or negative for each organism", "code_information": [{"code": "504U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease (vaginal infection), identification of 32 pathogenic organisms, swab, real-time PCR, reported as positive or negative for each organism", "code_information": [{"code": "505U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Infectious disease, bacterial vaginosis and vaginitis, real-time PCR amplification of DNA markers for Atopobium vaginae, Atopobium species, Megasphaera type 1, and Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), utilizing vaginal-fluid specimens, algo", "code_information": [{"code": "81515", "type": "CPT"}], "standard_charges": [{"minimum": 302.44, "maximum": 302.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 302.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine (IIV), H5, pandemic formulation, split virus, adjuvanted, for intramuscular use", "code_information": [{"code": "90631", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, H5N1, derived from cell cultures, adjuvanted, for intramuscular use", "code_information": [{"code": "90635", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use", "code_information": [{"code": "90695", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, quadrivalent (qIRV), mRNA; 30 mcg/0.5 mL dosage, for intramuscular use", "code_information": [{"code": "90637", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, quadrivalent (qIRV), mRNA; 60 mcg/0.5 mL dosage, for intramuscular use", "code_information": [{"code": "90638", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, quadrivalent, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 40 mcg/0.4 mL dosage, for intramuscular use", "code_information": [{"code": "90613", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, trivalent, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 31.7 mcg/0.32 mL dosage, for intramuscular use", "code_information": [{"code": "90612", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj avacincaptad pegol 0.1mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2782", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj brixadi, more than 7 day", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0578", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj cyclophosphamd (ingenus)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9073", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj daxibotulinumtoxina-lanm", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0589", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj hydroxocobalamin iv 25mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3424", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj melphalan (hepzato) 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9248", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj pozelimab-bbfg, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9376", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj talquetamab-tgvs 0.25 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, aflibercept hd, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0177", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, brixadi, 7 days or less", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0577", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, cipaglucosidase, 5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, cyclophosphamd, sandoz", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9074", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, cyclophosphamide, nos", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9075", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, elranatamab-bcmm, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1323", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, focinvez, 1mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1434", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, human-lans, per i.u", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7165", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, levothyroxine nos 10mcg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, levothyroxine, freskabi", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0651", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, levothyroxine, hikma", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0652", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, melphalan (apotex) 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, motixafortide, 0.25 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2277", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, rykindo, 0.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2801", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, sod thiosulfate (hope)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, tofidence, 1 mg", "code_information": [{"code": "Q5133", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, tyruko, 1 mg", "code_information": [{"code": "Q5134", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection(s), bone-substitute material for bone and/or soft tissue hardware fixation augmentation, including intraoperative imaging guidance, when performed", "code_information": [{"code": "869T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ADAMTS13, recombinant-krhn, 10 iu", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7171", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, acetaminophen 10 mg and ibuprofen 3 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0138", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, adalimumab, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0139", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, adalimumab-aacf (Idacio), biosimilar, 1 mg", "code_information": [{"code": "Q5144", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, adalimumab-aaty, biosimilar, 1 mg", "code_information": [{"code": "Q5141", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, adalimumab-adbm, biosimilar, 1 mg", "code_information": [{"code": "Q5143", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, adalimumab-afzb (Abrilada), biosimilar, 1 mg", "code_information": [{"code": "Q5145", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, adalimumab-fkjp, biosimilar, 1 mg", "code_information": [{"code": "Q5140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, adalimumab-ryvk biosimilar, 1 mg", "code_information": [{"code": "Q5142", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, aflibercept-abzv (Enzeevu), biosimilar, 1 mg", "code_information": [{"code": "Q5149", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, aflibercept-ayyh (Pavblu), biosimilar, 1 mg", "code_information": [{"code": "Q5147", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, aflibercept-mrbb (Ahzantive), biosimilar, 1 mg", "code_information": [{"code": "Q5150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, aflibercept-yszy (Opuviz), biosimilar, 1 mg", "code_information": [{"code": "Q5153", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, aminocaproic acid, 1 gram", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, atezolizumab, 5 mg and hyaluronidase-tqjs", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, atidarsagene autotemcel, per treatment", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3391", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, axatilimab-csfr, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, betibeglogene autotemcel, per treatment", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3393", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, bortezomib (Boruzu), 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9054", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, bupivacaine liposome, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0666", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, calcium chloride, 2 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0618", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, cefazolin sodium (WG Critical Care), not therapeutically equivalent to J0690, 500 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0687", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, cosibelimab-ipdl, 2 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, crovalimab-akkz, 10 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1307", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, cyclophosphamide (Baxter), 5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9076", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, daptomycin (Xellia), unrefrigerated, not therapeutically equivalent to J0878 or J0873, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0872", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, denileukin diftitox-cxdl, 1 mcg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, denosumab-bbdz (Jubbonti/Wyost), biosimilar, 1 mg", "code_information": [{"code": "Q5136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, diltiazem hydrochloride, 0.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1163", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, docetaxel (Beizray), 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9174", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, donanemab-azbt, 2 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, doxycycline hyclate, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1271", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, eculizumab, 2 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, eculizumab-aagh (Epysqli), biosimilar, 2 mg", "code_information": [{"code": "Q5151", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, eculizumab-aeeb (Bkemv), biosimilar, 2 mg", "code_information": [{"code": "Q5152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, efbemalenograstim alfa-vuxw, 0.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9361", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, epinephrine (BPI), not therapeutically equivalent to J0165, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0166", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, epinephrine (Hospira), not therapeutically equivalent to J0165, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0167", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, epinephrine (international medication systems), not therapeutically equivalent to J0165, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, epinephrine, not otherwise specified, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, exagamglogene autotemcel, per treatment", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3392", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1414", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, filgrastim-txid (Nypozi), biosimilar, 1 microgram", "code_information": [{"code": "Q5148", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, folic acid, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1808", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, glycopyrrolate (Fresenius Kabi), not therapeutically equivalent to J1596, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1598", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, glycopyrrolate (Glyrx-pf), 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1597", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, iloprost, 0.1 mcg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1749", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, imetelstat, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0870", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, immune globulin (Alyglo), 500 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, indigotindisulfonate sodium, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, infliximab-dyyb (Zymfentra), 10 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1748", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, lidocaine hcl in 5% dextrose, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, lovotibeglogene autotemcel, per treatment", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3394", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, marstacimab-hncq, 0.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, meropenem (WG Critical Care), not therapeutically equivalent to J2185, 100 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2183", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, metoprolol tartrate, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0616", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, micafungin in sodium (Baxter), not therapeutically equivalent to J2248, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, midazolam (Seizalam), 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2253", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, midazolam in 0.8% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2252", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, mirikizumab-mrkz, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2267", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, nafcillin sodium, 20 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, naloxone hydrochloride (Zimhi), 0.01 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, nivolumab, 2 mg and hyaluronidase-nvhy", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9289", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2351", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, paliperidone palmitate extended release (Erzofri), 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2428", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, palonosetron hydrochloride (Posfrea), 25 micrograms", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2468", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, pantoprazole (Hikma), not therapeutically equivalent to J2470, 40 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2471", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, pantoprazole sodium in sodium chloride (Baxter), 40 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2472", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, pegulicianine, 1 mg", "code_information": [{"code": "A9615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, pemetrexed dipotassium, 10 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9292", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, and who either have moderate-to-severe immune compromise due to a medic", "code_information": [{"code": "Q0224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, phenylephrine hydrochloride (Immphentiv), 20 micrograms", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2373", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, rifampin, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2804", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, romiplostim, 1 microgram", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2802", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, secukinumab, intravenous, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg (Nithiodote)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2865", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, tarlatamab-dlle, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, testosterone cypionate (Azmiro), 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1072", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, thiotepa (Tepylute), 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, thiotepa, not otherwise specified, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, tislelizumab-jsgr, 1mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9329", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, tocilizumab-aazg (Tyenne), biosimilar, 1 mg", "code_information": [{"code": "Q5135", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, tocilizumab-anoh, for hospitalized adult patients with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 m", "code_information": [{"code": "Q0237", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, toripalimab-tpzi, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3263", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, trastuzumab-strf (Hercessi), biosimilar, 10 mg", "code_information": [{"code": "Q5146", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, travoprost, intracameral implant, 1 microgram", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7355", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-aauz (Otulfi), biosimilar, 1 mg", "code_information": [{"code": "Q9999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-aekn (Selarsdi), biosimilar, 1 mg", "code_information": [{"code": "Q9998", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-auub (Wezlana), biosimilar, intravenous, 1 mg", "code_information": [{"code": "Q5138", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-auub (Wezlana), biosimilar, subcutaneous, 1 mg", "code_information": [{"code": "Q5137", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-kfce (Yesintek), biosimilar, 1 mg", "code_information": [{"code": "Q5100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-srlf (Imuldosa), biosimilar, 1 mg", "code_information": [{"code": "Q5098", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-stba (Steqeyma), biosimilar, 1 mg", "code_information": [{"code": "Q5099", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-ttwe (Pyzchiva), intravenous, 1 mg", "code_information": [{"code": "Q9997", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-ttwe (Pyzchiva), subcutaneous, 1 mg", "code_information": [{"code": "Q9996", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, vancomycin hydrochloride (xellia), not therapeutically equivalent to J3373, 10 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3375", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, vancomycin hydrochloride, 10 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, vasopressin (Baxter), 1 unit", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, zanidatamab-hrii, 2 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9276", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, zenocutuzumab-zbco, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, zolbetuximab-clzb, 2 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1326", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; dual transvenous leads (pacing and defibrillation) only", "code_information": [{"code": "918T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; pulse generator and dual transvenous electrodes/leads (pacin", "code_information": [{"code": "915T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; pulse generator only", "code_information": [{"code": "916T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; single transvenous lead (pacing or defibrillation) only", "code_information": [{"code": "917T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Insertion of transurethral ablation transducer for delivery of thermal ultrasound for prostate tissue ablation, including suprapubic tube placement during the same session and placement of an endorectal cooling device, when performed", "code_information": [{"code": "51721", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Insertion or replacement of epicranial neurostimulator system, including electrode array and pulse generator, with connection to electrode array", "code_information": [{"code": "968T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Instillation, taurolidine 1.35 mg and heparin sodium 100 units (central venous catheter lock for adult patients receiving chronic hemodialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0911", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty   whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includ", "code_information": [{"code": "G0546", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includin", "code_information": [{"code": "G0547", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includin", "code_information": [{"code": "G0548", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includin", "code_information": [{"code": "G0549", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, includin", "code_information": [{"code": "G0550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, 30", "code_information": [{"code": "G0551", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (in person) with analysis, review, and report, including connection, recording, and disconnection, per patient encounter, implantable cardiac contractility modulation-defibrillation system", "code_information": [{"code": "927T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system with interim analysis, review and report(s) by a physician or other qualified health care professional", "code_information": [{"code": "948T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system, remote data acquisition(s), receipt of transmissions, technician review, technical support, and distribution of results", "code_information": [{"code": "949T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation-defibrillation system with interim analysis and report(s) by a physician or other qualified health care professional", "code_information": [{"code": "928T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation-defibrillation system, remote data acquisition(s), receipt of transmissions, technician review, technical support, and distribution of results", "code_information": [{"code": "929T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intra-vag motion sens biofk", "code_information": [{"code": "S9002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intrabuccal, systemic delivery of amplitude-modulated, radiofrequency electromagnetic field device, for cancer treatment, includes all accessories", "code_information": [{"code": "E0767", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intraoperative assessment for abnormal (tumor) tissue, in-vivo, following partial mastectomy (eg, lumpectomy) using computer-aided fluorescence imaging (List separately in addition to code for primary procedure)", "code_information": [{"code": "945T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; each additional nerve (List separately in addition to code for primary proce", "code_information": [{"code": "883T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; initial nerve (List separately in addition to code for primary procedure)", "code_information": [{"code": "882T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intravaginal device intended to strengthen pelvic floor muscles during kegel exercises", "code_information": [{"code": "E0715", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intravascular imaging of extracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report; each additional ve", "code_information": [{"code": "985T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intravascular imaging of extracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report; initial vessel (Li", "code_information": [{"code": "984T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intravascular imaging of intracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report; each additional ve", "code_information": [{"code": "987T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intravascular imaging of intracranial cerebral vessels using optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention, including all associated radiological supervision, interpretation, and report; initial vessel (Li", "code_information": [{"code": "986T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to ", "code_information": [{"code": "M0224", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo", "code_information": [{"code": "M0237", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients withCOVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo)", "code_information": [{"code": "M0238", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Iv cipaglucosidase alfa-atga", "code_information": [{"code": "G0138", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE", "code_information": [{"code": "81270", "type": "CPT"}], "standard_charges": [{"minimum": 105.41, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 105.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQ ALYS", "code_information": [{"code": "27U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81279", "type": "CPT"}], "standard_charges": [{"minimum": 212.98, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JANSSEN VACC ADMIN BOOSTER", "code_information": [{"code": "D1712", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JANSSEN VACCINE ADMIN", "code_information": [{"code": "D1707", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JANUVIA (SITAGLIPTIN) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000769", "type": "CDM"}, {"code": "00006027731", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "JANUVIA 50MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001096", "type": "CDM"}, {"code": "00006011231", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 47.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "JARDIANCE (EMPAGLIFLOZIN) 10MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002899", "type": "CDM"}, {"code": "00597015230", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 56.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "JARDIANCE (EMPAGLIFLOZIN) 25MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004060", "type": "CDM"}, {"code": "00597015330", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 58.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "JAW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29800", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JAW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29804", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JEVITY 1.2 CAL", "code_information": [{"code": "80001254", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "JEVITY 1.5", "code_information": [{"code": "80001227", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "JK GNOTYP SLC14A1 EXON 9", "code_information": [{"code": "192U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JOHN CUNNINGHAM ANTIBODY", "code_information": [{"code": "86711", "type": "CPT"}], "standard_charges": [{"minimum": 19.42, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JOINT DEVICE (IMPLANTABLE)", "code_information": [{"code": "C1776", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JOINT SURVEY SINGLE VIEW", "code_information": [{"code": "77077", "type": "CPT"}], "standard_charges": [{"minimum": 59.85, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JR GNOTYP ABCG2 EXONS 2-26", "code_information": [{"code": "193U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JUST LIKE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200032", "type": "CDM"}, {"code": "00088221905", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "JUST LIKE IVPB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200034", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "JUVEN POWDER FOR SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002460", "type": "CDM"}, {"code": "59781066687", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Janumet Oral Tablet 50MG-500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002370", "type": "CDM"}, {"code": "00006057561", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Joint fusion and fixation device(s), sacroiliac and pelvis, including all system components (implantable)", "code_information": [{"code": "C1737", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE MULTIPLE", "code_information": [{"code": "78709", "type": "CPT"}], "standard_charges": [{"minimum": 441.92, "maximum": 441.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 441.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/DRUG", "code_information": [{"code": "78708", "type": "CPT"}], "standard_charges": [{"minimum": 221.38, "maximum": 221.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 221.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/O DRUG", "code_information": [{"code": "78707", "type": "CPT"}], "standard_charges": [{"minimum": 278.12, "maximum": 278.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 278.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "K PAD", "code_information": [{"code": "3000218", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "K PHOS NEUTRAL (PHOSPHORUS) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000261", "type": "CDM"}, {"code": "64980010401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "K-PHOS ORIGINAL TABLET 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001116", "type": "CDM"}, {"code": "00486111101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "K-Y JELLY 2 OZ", "code_information": [{"code": "3000223", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "K-Y JELLY LUBRICATING", "code_information": [{"code": "3000224", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KAROTYPE", "code_information": [{"code": "88230", "type": "CPT"}, {"code": "1000632", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 92.12, "maximum": 620.62, "gross_charge": 689.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 133.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 551.66, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 620.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 393.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KAYEXALATE(sod polystyr) SUS 15GM/60ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000255", "type": "CDM"}, {"code": "46287000660", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 6.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEFLEX (CEPHALEXIN) 500MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003466", "type": "CDM"}, {"code": "65862001905", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEFLEX (CEPHALEXIN) CAP 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000094", "type": "CDM"}, {"code": "00904733661", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEFLEX (CEPHALEXIN) SUSP 125MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000096", "type": "CDM"}, {"code": "00093417573", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEFLEX (CEPHALEXIN) SUSP 250MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000097", "type": "CDM"}, {"code": "67877054568", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEL GNOTYP KEL EXON 8", "code_information": [{"code": "194U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KENALOG (TRIAMCIN ACE) 40MG/ML INJ", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J3301", "type": "HCPCS"}, {"code": "72000509", "type": "CDM"}, {"code": "00003029305", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KEPPRA (LEVETIRACETAM) 100MG/ML SDV", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J1953", "type": "HCPCS"}, {"code": "72004336", "type": "CDM"}, {"code": "72485010610", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KEPPRA (LEVETIRACETAM) 750MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002548", "type": "CDM"}, {"code": "00904712561", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEPPRA (LEVETIRACETAM) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000428", "type": "CDM"}, {"code": "00904712461", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEPPRA ER (LEVETIRACETAM ER) 500MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001139", "type": "CDM"}, {"code": "43547034506", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEPPRA ORAL SOLN 100MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000601", "type": "CDM"}, {"code": "65862025047", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KERAMATRIX, KERASORB SQ CM", "code_information": [{"code": "Q4165", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KERECIS MARIGEN SHLD SQ CM", "code_information": [{"code": "A2019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KERECIS OMEGA3, PER SQ CM", "code_information": [{"code": "Q4158", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KERLIX ROLL KEN", "code_information": [{"code": "3000516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KEROXX (2.5G/CC), 1CC", "code_information": [{"code": "Q4202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KETAMINE (KETALAR HCL) INJ SOL 50MG/1ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "72001086", "type": "CDM"}, {"code": "00143950810", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 10.26, "maximum": 16.2, "gross_charge": 18.0, "discounted_cash": 54.17, "estimated_discounted_cash": 30.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KETAMINE AND NORKETAMINE", "code_information": [{"code": "80357", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KETOPROFEN CAP 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000259", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [{"code": "657", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC", "code_information": [{"code": "656", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "658", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [{"code": "660", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [{"code": "659", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "661", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [{"code": "689", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 5034.3, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [{"code": "690", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 3727.84, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [{"code": "687", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [{"code": "686", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "688", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "695", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "696", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY DIALYSATE DELIVRY SYS", "code_information": [{"code": "E1510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50551", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50553", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50575", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50555", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50574", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50557", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50561", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50576", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50580", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY FUNCTION STUDY", "code_information": [{"code": "78725", "type": "CPT"}], "standard_charges": [{"minimum": 140.21, "maximum": 140.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING MORPHOL", "code_information": [{"code": "78700", "type": "CPT"}], "standard_charges": [{"minimum": 203.65, "maximum": 203.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 203.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING WITH FLOW", "code_information": [{"code": "78701", "type": "CPT"}], "standard_charges": [{"minimum": 262.77, "maximum": 262.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 262.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY STONE ANALYSIS", "code_information": [{"code": "82365", "type": "CPT"}, {"code": "1000288", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.84, "maximum": 68.68, "gross_charge": 76.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT", "code_information": [{"code": "652", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [{"code": "650", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [{"code": "651", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KIT GENE ANALYS D816 VARIANT", "code_information": [{"code": "81273", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 143.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 143.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIT GENE TARGETED SEQ ANALYS", "code_information": [{"code": "81272", "type": "CPT"}], "standard_charges": [{"minimum": 378.94, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 378.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KLEENEX", "code_information": [{"code": "3000044", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KLF1 TARGETED SEQUENCING", "code_information": [{"code": "195U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KLHL11 ANTB SR/CSF ASY QUAL", "code_information": [{"code": "432U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KLING ELASTIC 2", "code_information": [{"code": "3000517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KLING ELASTIC 3", "code_information": [{"code": "3000518", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KLING ELASTIC 4", "code_information": [{"code": "3000519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KLING ELASTIC 6", "code_information": [{"code": "3000520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KLONOPIN (CLONAZEPAM) TAB 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000465", "type": "CDM"}, {"code": "00904722761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KLONOPIN (CLONAZEPAM) TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000117", "type": "CDM"}, {"code": "59651072301", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KLONOPIN LEVEL", "code_information": [{"code": "80346", "type": "CPT"}, {"code": "1000232", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "gross_charge": 109.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.57, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY DX", "code_information": [{"code": "29870", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/DRAINAGE", "code_information": [{"code": "29871", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29850", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29851", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29873", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29874", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29875", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29876", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29877", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29879", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29880", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29881", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29882", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29883", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29884", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29885", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29886", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29887", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29888", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29889", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCP HARV", "code_information": [{"code": "S2112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [{"code": "486", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [{"code": "485", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "487", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC", "code_information": [{"code": "488", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "489", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "KNEE SLEEVE SPLINT L", "code_information": [{"code": "3000219", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KNEE SLEEVE SPLINT M", "code_information": [{"code": "3000220", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KNEE SLEEVE SPLINT S", "code_information": [{"code": "3000221", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KNEE SLEEVE SPLINT X", "code_information": [{"code": "3000222", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KRAS GENE ADDL VARIANTS", "code_information": [{"code": "81276", "type": "CPT"}], "standard_charges": [{"minimum": 222.24, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 222.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KRAS GENE VARIANTS EXON 2", "code_information": [{"code": "81275", "type": "CPT"}], "standard_charges": [{"minimum": 222.24, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 222.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KRAS OR NRAS GENE MUTATION", "code_information": [{"code": "G9843", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KT/V <1.2", "code_information": [{"code": "3082F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KT/V =/> 1.2 & <1.7", "code_information": [{"code": "3083F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KT/V >= 1.7", "code_information": [{"code": "3084F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KYLEENA, 19.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7296", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 1-2 SEGMENTS", "code_information": [{"code": "22818", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 3 OR MORE", "code_information": [{"code": "22819", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf", "code_information": [{"code": "L1821", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44207", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44208", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7523", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7524", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT ART/GRFT ANGIO", "code_information": [{"code": "93459", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT ARTERY/VENTRICLE ANGIO", "code_information": [{"code": "93458", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT CATH CHD NM/ABN NT CNJ", "code_information": [{"code": "93595", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT CATH TRNSPTL PUNCTURE", "code_information": [{"code": "93462", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/ IVUS OR OCT", "code_information": [{"code": "C7525", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L VENTRIC PACING LEAD ADD-ON", "code_information": [{"code": "33225", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L/S RATIO FETAL LUNG", "code_information": [{"code": "83661", "type": "CPT"}], "standard_charges": [{"minimum": 25.29, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAB PROCESS MICROBIAL SPEC", "code_information": [{"code": "D0414", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LABELS-DIETARY", "code_information": [{"code": "80000831", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LABIAL VENEER PORC INDIRECT", "code_information": [{"code": "D2962", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LABIAL VENEER RESIN DIRECT", "code_information": [{"code": "D2960", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LABIAL VENEER RESIN INDIRECT", "code_information": [{"code": "D2961", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LACERATION TRAY/I & D TRAY", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "3001343", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LACT RINGERS/DEXTROSE 5% : 1000ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7121", "type": "HCPCS"}, {"code": "7200024", "type": "CDM"}, {"code": "00338012504", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 7.25, "maximum": 11.44, "gross_charge": 12.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 11.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTATE DEHYDROGENASE", "code_information": [{"code": "83615", "type": "CPT"}, {"code": "1000178", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.95, "maximum": 32.15, "gross_charge": 35.73, "discounted_cash": 54.17, "estimated_discounted_cash": 35.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.58, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTATE DEHYDROGENASE ISOENZYMES", "code_information": [{"code": "83625", "type": "CPT"}, {"code": "1000062", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.71, "maximum": 68.17, "gross_charge": 75.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 60.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTATED RINGERS IV 1000ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7120", "type": "HCPCS"}, {"code": "7000513", "type": "CDM"}, {"code": "00338011704", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.23, "maximum": 14.58, "gross_charge": 16.2, "discounted_cash": 54.17, "estimated_discounted_cash": 22.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTATED RINGERS IVSL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7120", "type": "HCPCS"}, {"code": "7000514", "type": "CDM"}, {"code": "00338011704", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 14.25, "maximum": 22.5, "gross_charge": 25.0, "discounted_cash": 54.17, "estimated_discounted_cash": 22.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTATION CLASS", "code_information": [{"code": "S9443", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LACTIC ACID PLASMA", "code_information": [{"code": "83605", "type": "CPT"}, {"code": "1000245", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.31, "maximum": 56.88, "gross_charge": 63.21, "discounted_cash": 54.17, "estimated_discounted_cash": 64.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 56.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTOFERRIN FECAL (QUAL)", "code_information": [{"code": "83630", "type": "CPT"}], "standard_charges": [{"minimum": 22.66, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LADIES SHOES HIGHTOP DEPTH I", "code_information": [{"code": "L3217", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAETRILE AMYGDALIN VIT B17", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAIV VACC PANDEMIC INTRANASL", "code_information": [{"code": "90664", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAIV3 VACCINE INTRANASAL", "code_information": [{"code": "90660", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAIV4 VACCINE INTRANASAL", "code_information": [{"code": "90672", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAM FACETC/FRMT ARTHRD LUM 1", "code_information": [{"code": "63052", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT CRV", "code_information": [{"code": "63045", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT LUMBAR", "code_information": [{"code": "63047", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT THRC", "code_information": [{"code": "63046", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC &FORAMOT EA ADDL", "code_information": [{"code": "63048", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAM FACTC/FRMT ARTHRD LUM EA", "code_information": [{"code": "63053", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAM W/CORDOTOMY 1STG THRC", "code_information": [{"code": "63197", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMAZE CLASS", "code_information": [{"code": "S9436", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMB WOOL", "code_information": [{"code": "3001185", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAMELLAR BDY FETAL LUNG", "code_information": [{"code": "83664", "type": "CPT"}], "standard_charges": [{"minimum": 22.22, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMELLAS XT, PER SQ CM", "code_information": [{"code": "Q4291", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMELLAS, PER SQ CM", "code_information": [{"code": "Q4292", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMICTAL (LAMITRIGINE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000797", "type": "CDM"}, {"code": "68084031901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAMICTAL (LAMOTRIGINE) 200MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004318", "type": "CDM"}, {"code": "65862023060", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAMICTAL ER (NF-LaMICtal ER) 25MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002800", "type": "CDM"}, {"code": "65162094903", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAMICTAL LEVEL LAMOTRIGINE", "code_information": [{"code": "80299", "type": "CPT"}, {"code": "1000081", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 21.44, "maximum": 98.1, "gross_charge": 109.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY ADDL CERVICAL", "code_information": [{"code": "63043", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY ADDL LUMBAR", "code_information": [{"code": "63044", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY SINGLE CERVICAL", "code_information": [{"code": "63040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY SINGLE LUMBAR", "code_information": [{"code": "63042", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMISIL (TERBINAFINE) 1% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000265", "type": "CDM"}, {"code": "00067399942", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAMP 4.6V HPX VAGINAL LIGHT (08800-U)", "code_information": [{"code": "80000824", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LANCET SAFETY UNISTIK 2 NORM", "code_information": [{"code": "3000521", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LANGUAGE SCREENING", "code_information": [{"code": "V5363", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LANOXIN (DIGOXIN) 0.5MG/2ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1160", "type": "HCPCS"}, {"code": "7000267", "type": "CDM"}, {"code": "00641141035", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANOXIN (DIGOXIN) TAB 0.125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000268", "type": "CDM"}, {"code": "50268023815", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LANREOTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1930", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LANTUS SOLOSTAR SUBQ SOLUTION 100U/1ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001047", "type": "CDM"}, {"code": "00088221905", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.92, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAP CLOSE ENTEROSTOMY", "code_information": [{"code": "44227", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY PART W/ILEUM", "code_information": [{"code": "44205", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY W/PROCTECTOMY", "code_information": [{"code": "44211", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP COLOSTOMY", "code_information": [{"code": "44188", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ENTERECTOMY", "code_information": [{"code": "44202", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ENTEROLYSIS", "code_information": [{"code": "44180", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ESOPH LENGTHENING", "code_information": [{"code": "43283", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ESOPHAGOMYOTOMY", "code_information": [{"code": "S2079", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP GASTR BYPASS INCL SMLL I", "code_information": [{"code": "43645", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP GASTRIC BYPASS/ROUX-EN-Y", "code_information": [{"code": "43644", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ILEO/JEJUNO-STOMY", "code_information": [{"code": "44187", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP IMPL ELECTRODE ANTRUM", "code_information": [{"code": "43647", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ING HERNIA REPAIR INIT", "code_information": [{"code": "49650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ING HERNIA REPAIR RECUR", "code_information": [{"code": "49651", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP INS DEVICE FOR RT", "code_information": [{"code": "49327", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP INSERT TUNNEL IP CATH", "code_information": [{"code": "49324", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP JEJUNOSTOMY", "code_information": [{"code": "44186", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP MOBIL SPLENIC FL ADD-ON", "code_information": [{"code": "44213", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP MYOTOMY HELLER", "code_information": [{"code": "43279", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPH HER RPR W/MESH", "code_information": [{"code": "43282", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPHAG HERN REPAIR", "code_information": [{"code": "43281", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP PART COLECTOMY W/STOMA", "code_information": [{"code": "44206", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP PLACE GASTR ADJ DEVICE", "code_information": [{"code": "43770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP PROCTOPEXY W/SIG RESECT", "code_information": [{"code": "45402", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP RADICAL HYST", "code_information": [{"code": "58548", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REMOVAL OF RECTUM", "code_information": [{"code": "45395", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REMOVE RECTUM W/POUCH", "code_information": [{"code": "45397", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REPLACE GASTR ADJ DEVICE", "code_information": [{"code": "43773", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP RESECT S/INTESTINE ADDL", "code_information": [{"code": "44203", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REVISE GASTR ADJ DEVICE", "code_information": [{"code": "43771", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REVISE/REMV ELTRD ANTRUM", "code_information": [{"code": "43648", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REVISION PERM IP CATH", "code_information": [{"code": "49325", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ ALL PARTS", "code_information": [{"code": "43774", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ DEVICE", "code_information": [{"code": "43772", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP SLEEVE GASTRECTOMY", "code_information": [{"code": "43775", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP W/OMENTOPEXY ADD-ON", "code_information": [{"code": "49326", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER CRYOSURG", "code_information": [{"code": "47371", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER TUMOR RF", "code_information": [{"code": "47370", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL CYST", "code_information": [{"code": "50541", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL MASS", "code_information": [{"code": "50542", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/EXPLR", "code_information": [{"code": "47564", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/GRAPH", "code_information": [{"code": "47563", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTOENTEROSTOMY", "code_information": [{"code": "47570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO DRAIN LYMPHOCELE", "code_information": [{"code": "49323", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO LIGATE SPERMATIC VEIN", "code_information": [{"code": "55550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50947", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50948", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL COLECTOMY", "code_information": [{"code": "44204", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL NEPHRECTOMY", "code_information": [{"code": "50543", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO RADICAL NEPHRECTOMY", "code_information": [{"code": "50545", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVAL DONOR KIDNEY", "code_information": [{"code": "50547", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVE W/URETER", "code_information": [{"code": "50548", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO SLING OPERATION", "code_information": [{"code": "51992", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44212", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO URETHRAL SUSPENSION", "code_information": [{"code": "51990", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO-ASST VAG HYSTERECTOMY", "code_information": [{"code": "58550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO-MYOMECTOMY COMPLEX", "code_information": [{"code": "58546", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST COMPLEX", "code_information": [{"code": "58553", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST INCL T/O", "code_information": [{"code": "58552", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST W/T/O COMPL", "code_information": [{"code": "58554", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPE PROC RECTUM", "code_information": [{"code": "45499", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY", "code_information": [{"code": "47562", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [{"code": "418", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "417", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "419", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC MYOMECTOMY", "code_information": [{"code": "58545", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC NEPHRECTOMY", "code_information": [{"code": "50546", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC PROC", "code_information": [{"code": "45400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ADRENALECTOMY", "code_information": [{"code": "60650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY APPENDECTOMY", "code_information": [{"code": "44970", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ASPIRATION", "code_information": [{"code": "49322", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY BIOPSY", "code_information": [{"code": "49321", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY EXCISE LESIONS", "code_information": [{"code": "58662", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FIMBRIOPLASTY", "code_information": [{"code": "58672", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FUNDOPLASTY", "code_information": [{"code": "43280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY GASTROSTOMY", "code_information": [{"code": "43653", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ISLET CELL TRANS", "code_information": [{"code": "G0342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPH NODE BIOP", "code_information": [{"code": "38570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38571", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYSIS", "code_information": [{"code": "58660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIECTOMY", "code_information": [{"code": "54690", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIOPEXY", "code_information": [{"code": "54692", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY PYELOPLASTY", "code_information": [{"code": "50544", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY REMOVE ADNEXA", "code_information": [{"code": "58661", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SALPINGOSTOMY", "code_information": [{"code": "58673", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SPLENECTOMY", "code_information": [{"code": "38120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURG COLPOPEXY", "code_information": [{"code": "57425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY TUBAL BLOCK", "code_information": [{"code": "58671", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY TUBAL CAUTERY", "code_information": [{"code": "58670", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY URETEROLITHOTOMY", "code_information": [{"code": "50945", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43651", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43652", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROTOMY ISLET CELL TRANSP", "code_information": [{"code": "G0343", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROTOMY SHEET DISPOSABLE", "code_information": [{"code": "3000225", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAPS ABLTJ UTERINE FIBROIDS", "code_information": [{"code": "58674", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS ESOPHGL SPHNCTR AGMNTJ", "code_information": [{"code": "43284", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS 1LD", "code_information": [{"code": "675T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS EA", "code_information": [{"code": "676T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT PRM ISDSS", "code_information": [{"code": "674T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS ISLET CELL TRANSPLANT", "code_information": [{"code": "585T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS PELVIC LYMPHADEC", "code_information": [{"code": "38573", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS 1ST LD", "code_information": [{"code": "677T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS EA ADD", "code_information": [{"code": "678T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS RMVL LEAD ISDSS", "code_information": [{"code": "679T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT RPBIC RAD", "code_information": [{"code": "55866", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT SMPL STOT", "code_information": [{"code": "55867", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS TOT HYST RESJ MAL", "code_information": [{"code": "58575", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGE DISPOSABLE UNDERPAD", "code_information": [{"code": "T4541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGSC W/LASER DSTRJ LES", "code_information": [{"code": "31572", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGSC W/NJX AUGMENTATION", "code_information": [{"code": "31574", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGSC W/REMOVAL LESION", "code_information": [{"code": "31578", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGSC W/RMVL FOREIGN BDY(S)", "code_information": [{"code": "31577", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGSC W/THER INJECTION", "code_information": [{"code": "31573", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARONIDASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1931", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGEAL FUNCTION STUDIES", "code_information": [{"code": "92520", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY CRICOID SPLIT", "code_information": [{"code": "31587", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY FX RDCTJ FIXJ", "code_information": [{"code": "31584", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31551", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31552", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31553", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31554", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL WEB", "code_information": [{"code": "31580", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY MEDIALIZATION", "code_information": [{"code": "31591", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/ARYTENOIDECTOM", "code_information": [{"code": "31560", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/VC INJ + SCOPE", "code_information": [{"code": "31571", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE W/VC INJ", "code_information": [{"code": "31570", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY I&R", "code_information": [{"code": "92615", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY VID", "code_information": [{"code": "92614", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31528", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31529", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR ASPIRATION", "code_information": [{"code": "31515", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR TREATMENT", "code_information": [{"code": "31527", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY TELESCOPIC", "code_information": [{"code": "31579", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BIOPSY", "code_information": [{"code": "31535", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BX & OP SCOPE", "code_information": [{"code": "31536", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/EXC OF TUMOR", "code_information": [{"code": "31540", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB & OP SCOPE", "code_information": [{"code": "31531", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB REMOVAL", "code_information": [{"code": "31530", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31510", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31576", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP REMVE CART + SCOP", "code_information": [{"code": "31561", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP W/TUMR EXC + SCOPE", "code_information": [{"code": "31541", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER IN SITU KERATOMILEUSIS", "code_information": [{"code": "S0800", "type": "HCPCS"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER SURG PENIS LESION(S)", "code_information": [{"code": "54057", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY ANAL LESIONS", "code_information": [{"code": "46917", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY EYE STRANDS", "code_information": [{"code": "67031", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF CERVIX", "code_information": [{"code": "57513", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52647", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52648", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67039", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67040", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LASIX (FUROSEMIDE) 20MG INJ", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J1940", "type": "HCPCS"}, {"code": "72000578", "type": "CDM"}, {"code": "71288020303", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "estimated_discounted_cash": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LASIX (FUROSEMIDE) 40MG INJ", "drug_information": {"unit": 40.0, "type": "EA"}, "code_information": [{"code": "J1938", "type": "HCPCS"}, {"code": "72000579", "type": "CDM"}, {"code": "71288020305", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 16.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASIX (FUROSEMIDE) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000205", "type": "CDM"}, {"code": "00904717761", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LASIX (FUROSEMIDE) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000270", "type": "CDM"}, {"code": "00904717861", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAT RETINACULAR RELEASE OPEN", "code_information": [{"code": "27425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LATUDA TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002111", "type": "CDM"}, {"code": "63402030230", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.46, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAUNDRY SERV,EXT,PROF,/ORDER", "code_information": [{"code": "S5175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAUP", "code_information": [{"code": "S2080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAVACUATOR 22 FR CLEAR", "code_information": [{"code": "3001441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LAVACUATOR 36 FR CLEAR", "code_information": [{"code": "3001206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LDH-BODY FLUID", "code_information": [{"code": "83615", "type": "CPT"}, {"code": "1000701", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.95, "maximum": 32.15, "gross_charge": 35.73, "discounted_cash": 54.17, "estimated_discounted_cash": 35.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.58, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LDL DIRECT", "code_information": [{"code": "83721", "type": "CPT"}, {"code": "1000981", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.08, "maximum": 47.76, "gross_charge": 53.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.45, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LDL-C 100-129 MG/DL", "code_information": [{"code": "3049F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LDL-C <100 MG/DL", "code_information": [{"code": "3048F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LDL-C >= 130 MG/DL", "code_information": [{"code": "3050F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LDR PROSTATE BRACHY COMP RAT", "code_information": [{"code": "G0458", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD LEVEL ADULT", "code_information": [{"code": "83655", "type": "CPT"}, {"code": "1000637", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.93, "maximum": 64.47, "gross_charge": 71.64, "discounted_cash": 54.17, "estimated_discounted_cash": 77.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD LEVEL PEDIATRIC", "code_information": [{"code": "83655", "type": "CPT"}, {"code": "1000179", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.93, "maximum": 64.47, "gross_charge": 71.64, "discounted_cash": 54.17, "estimated_discounted_cash": 77.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD, AICD, ENDO DUAL COIL", "code_information": [{"code": "C1895", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, AICD, ENDO SINGLE COIL", "code_information": [{"code": "C1777", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, AICD, NON SING/DUAL", "code_information": [{"code": "C1896", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, CORONARY VENOUS", "code_information": [{"code": "C1900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, NEUROSTIM TEST KIT", "code_information": [{"code": "C1897", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, NEUROSTIMULATOR", "code_information": [{"code": "C1778", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, PMKR, OTHER THAN TRANS", "code_information": [{"code": "C1898", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, PMKR, TRANSVENOUS VDD", "code_information": [{"code": "C1779", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, PMKR/AICD COMBINATION", "code_information": [{"code": "C1899", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LECITHIN 1200MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004230", "type": "CDM"}, {"code": "39686001415", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/ GRAFT", "code_information": [{"code": "21145", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/O GRAFT", "code_information": [{"code": "21141", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/ GRAFT", "code_information": [{"code": "21146", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/O GRAFT", "code_information": [{"code": "21142", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/ GRAFT", "code_information": [{"code": "21147", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/O GRAFT", "code_information": [{"code": "21143", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT II ANTERIOR INTRUSION", "code_information": [{"code": "21150", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT II W/BONE GRAFTS", "code_information": [{"code": "21151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/ LEFORT I", "code_information": [{"code": "21155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHD W/ LEFORT I", "code_information": [{"code": "21160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHDW/O LEFORT I", "code_information": [{"code": "21159", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/O LEFORT I", "code_information": [{"code": "21154", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFT HRT CATH W/VENTRCLGRPHY", "code_information": [{"code": "93452", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEG PAIN NO VAS", "code_information": [{"code": "G9949", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEG PAIN VAS 6-20WK <= 3", "code_information": [{"code": "G2140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEG PAIN VAS 6-20WK > 3", "code_information": [{"code": "G2141", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEG PAIN VAS 9-15MO <= 3", "code_information": [{"code": "G2146", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEG PAIN VAS 9-15MO > 3", "code_information": [{"code": "G2147", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEG VEIN FUSION", "code_information": [{"code": "34530", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA AMP PROB", "code_information": [{"code": "87541", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA DIR PROB", "code_information": [{"code": "87540", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA QUANT", "code_information": [{"code": "87542", "type": "CPT"}], "standard_charges": [{"minimum": 48.02, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMOPHILIA AG IF", "code_information": [{"code": "87278", "type": "CPT"}], "standard_charges": [{"minimum": 17.94, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA PNEUMO AB SERUM", "code_information": [{"code": "86713", "type": "CPT"}, {"code": "1000501", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 17.6, "maximum": 96.7, "gross_charge": 90.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 72.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 81.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 51.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA PNEUMOPHILA URINARY ANTIGEN", "code_information": [{"code": "87449", "type": "CPT"}, {"code": "1000543", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.78, "maximum": 103.5, "gross_charge": 115.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEISHMANIA ANTIBODY", "code_information": [{"code": "86717", "type": "CPT"}], "standard_charges": [{"minimum": 14.09, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHEN METACARPAL/FINGER", "code_information": [{"code": "26568", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS & ULNA", "code_information": [{"code": "25393", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS OR ULNA", "code_information": [{"code": "25391", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF HAND TENDON", "code_information": [{"code": "26478", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42226", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42227", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH BONE", "code_information": [{"code": "27466", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDON", "code_information": [{"code": "27393", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27394", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27395", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENS BIFOCAL SPECIALITY", "code_information": [{"code": "V2299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENS SINGLE VISION NOT OTH C", "code_information": [{"code": "V2199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENS TRIFOCAL SPECIALITY", "code_information": [{"code": "V2399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENS, INTRAOCULAR (NEW TECH)", "code_information": [{"code": "C1780", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEPIRUDIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1945", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEPTOSPIRA ANTIBODY", "code_information": [{"code": "86720", "type": "CPT"}], "standard_charges": [{"minimum": 18.63, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LESION DESTRUCTION", "code_information": [{"code": "D7465", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUCOVORIN CALCIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0640", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUKACYTE TRANSFUSION", "code_information": [{"code": "86950", "type": "CPT"}], "standard_charges": [{"minimum": 78.45, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE ASSESSMENT FECAL", "code_information": [{"code": "89055", "type": "CPT"}], "standard_charges": [{"minimum": 4.91, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE HISTAMINE RELEASE", "code_information": [{"code": "86343", "type": "CPT"}], "standard_charges": [{"minimum": 14.33, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE PHAGOCYTOSIS", "code_information": [{"code": "86344", "type": "CPT"}], "standard_charges": [{"minimum": 11.95, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE /3.75 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1950", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9219", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9218", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE SUSPNSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9217", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE DEPOT CIPLA 7.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1954", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE INJ, CAMCEVI, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1952", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEV 1 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEV 2 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0381", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEV 3 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEV 4 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0383", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEV 5 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0384", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7612", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7614", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVAMISOLE 50 MG", "code_information": [{"code": "S0177", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVAQUIN (LEVOFLOXACIN) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000275", "type": "CDM"}, {"code": "00904635161", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVAQUIN (LEVOFLOXACIN) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000276", "type": "CDM"}, {"code": "00904635261", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVAQUIN (LEVOFLOXACIN) TAB 750MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1956", "type": "HCPCS"}, {"code": "72000482", "type": "CDM"}, {"code": "00781334355", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 23.37, "maximum": 36.9, "gross_charge": 41.0, "discounted_cash": 54.17, "estimated_discounted_cash": 69.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 23.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVAQUIN 250MG/50ML D5W IVPB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1956", "type": "HCPCS"}, {"code": "7000277", "type": "CDM"}, {"code": "25021013281", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 20.29, "maximum": 32.04, "gross_charge": 35.6, "discounted_cash": 54.17, "estimated_discounted_cash": 69.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVAQUIN 500MG/100ML D5W IVPB", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J1956", "type": "HCPCS"}, {"code": "72000507", "type": "CDM"}, {"code": "00143972101", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 40.64, "maximum": 64.17, "gross_charge": 71.3, "discounted_cash": 54.17, "estimated_discounted_cash": 69.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVAQUIN 750MG/150ML D5W IVPB", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J1956", "type": "HCPCS"}, {"code": "72000508", "type": "CDM"}, {"code": "00143931701", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 53.92, "maximum": 85.14, "gross_charge": 94.6, "discounted_cash": 54.17, "estimated_discounted_cash": 69.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 70.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 75.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 85.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 53.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEEN/SHUNT PATENCY EXAM", "code_information": [{"code": "78291", "type": "CPT"}], "standard_charges": [{"minimum": 312.97, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 312.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVEL OF ACTIVITY ASSESS", "code_information": [{"code": "1003F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVEMIR FLEXTOUCH SUBQ SOLN 100U/1ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001045", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVETIRACETAM-KEPPRA", "code_information": [{"code": "80177", "type": "CPT"}, {"code": "1000478", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.24, "maximum": 96.2, "gross_charge": 106.89, "discounted_cash": 54.17, "estimated_discounted_cash": 107.74, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.92, "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": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVOPHED (NOREPINEPHRINE) 1MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "72000991", "type": "CDM"}, {"code": "67457085204", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 30.56, "maximum": 48.25, "gross_charge": 53.62, "discounted_cash": 54.17, "estimated_discounted_cash": 30.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 48.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.56, "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": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVOTHYROXINE SODIUM TAB 125MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000279", "type": "CDM"}, {"code": "00527163801", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVSIN TAB 0.125", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000215", "type": "CDM"}, {"code": "42192034001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEXAPRO (ESCITALOPRAM OXALATE) 10MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000283", "type": "CDM"}, {"code": "00904642661", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LG PN NOT MEAS W/ VAS 1YR PO", "code_information": [{"code": "M1052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIBRIUM (CHLORDIAZEPOXIDE) CAP 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000102", "type": "CDM"}, {"code": "00555003302", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIBRIUM (CHLORDIAZEPOXIDE) CAP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000103", "type": "CDM"}, {"code": "51079014120", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LICE TREATMENT, TOPICAL", "code_information": [{"code": "A9180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% JELLY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000490", "type": "CDM"}, {"code": "25021067376", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIDOCAINE OINTMENT 5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000167", "type": "CDM"}, {"code": "00168020437", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 111.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIDOCAINE VISCOUS 20MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000286", "type": "CDM"}, {"code": "72888012526", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIDODERM (LIDOCAINE) PATCH 5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000165", "type": "CDM"}, {"code": "00603188016", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 1ST STAGE", "code_information": [{"code": "S0340", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 2 OR 3 STAGE", "code_information": [{"code": "S0341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 4TH STAGE", "code_information": [{"code": "S0342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE ESOPHAGUS VEINS", "code_information": [{"code": "43400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS OPEN", "code_information": [{"code": "37761", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS RADICAL", "code_information": [{"code": "37760", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE OVIDUCT(S) ADD-ON", "code_information": [{"code": "58611", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE/DIVIDE/EXCISE VEIN", "code_information": [{"code": "37785", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE/STAPLE ESOPHAGUS", "code_information": [{"code": "43405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP LONG LEG VEIN", "code_information": [{"code": "37722", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP SHORT LEG VEIN", "code_information": [{"code": "37718", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION NASAL SINUS ARTERY", "code_information": [{"code": "30915", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF A-V FISTULA", "code_information": [{"code": "37607", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF ABDOMEN ARTERY", "code_information": [{"code": "37617", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF CHEST ARTERY", "code_information": [{"code": "37616", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF EXTREMITY ARTERY", "code_information": [{"code": "37618", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF HEMORRHOID(S)", "code_information": [{"code": "46221", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF INF VENA CAVA", "code_information": [{"code": "37619", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37600", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37605", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37606", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37615", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK VEIN", "code_information": [{"code": "37565", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SALIVARY DUCT", "code_information": [{"code": "42665", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SHUNT", "code_information": [{"code": "49428", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION UPPER JAW ARTERY", "code_information": [{"code": "30920", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LILETTA, 52 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7297", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMB EXERCISE TEST", "code_information": [{"code": "95875", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMB NERVE SURGERY ADD-ON", "code_information": [{"code": "64783", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "956", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LIMIT ORAL EVAL PROBLM FOCUS", "code_information": [{"code": "D0140", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED AUTOPSY", "code_information": [{"code": "88036", "type": "CPT"}], "standard_charges": [{"minimum": 108.14, "maximum": 108.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 108.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED AUTOPSY", "code_information": [{"code": "88037", "type": "CPT"}], "standard_charges": [{"minimum": 96.12, "maximum": 96.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 96.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX ADOLESCENT", "code_information": [{"code": "D8030", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX ADULT", "code_information": [{"code": "D8040", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX PRIMARY", "code_information": [{"code": "D8010", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX TRANSITION", "code_information": [{"code": "D8020", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED OCCLUSAL ADJUSTMENT", "code_information": [{"code": "D9951", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIMITED VISUAL FIELD XM", "code_information": [{"code": "92081", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LINCOCIN (LINCOMYCIN) 300MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2010", "type": "HCPCS"}, {"code": "7000287", "type": "CDM"}, {"code": "00009055502", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 55.31, "maximum": 87.34, "gross_charge": 97.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 72.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER 24X23 RED 1ML", "code_information": [{"code": "80000707", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 1368.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LINER 24X30 WHITE 0.5MIL (15X9X32)", "code_information": [{"code": "80000853", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 150.72, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LINER COMPL/PARTIAL REM DENT", "code_information": [{"code": "D5765", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LINGUAL FRENECTOMY", "code_information": [{"code": "D7962", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LINZESS (LINACLOTIDE) 72MCG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002691", "type": "CDM"}, {"code": "00456120330", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 53.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LINZESS CAP 145MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000976", "type": "CDM"}, {"code": "00456120130", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LINZESS CAP 290MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001259", "type": "CDM"}, {"code": "00456120230", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIPASE", "code_information": [{"code": "83690", "type": "CPT"}, {"code": "1000180", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.92, "maximum": 36.69, "gross_charge": 40.77, "discounted_cash": 54.17, "estimated_discounted_cash": 40.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPASE BODY FLUID", "code_information": [{"code": "83690", "type": "CPT"}, {"code": "1000993", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.92, "maximum": 36.69, "gross_charge": 40.77, "discounted_cash": 54.17, "estimated_discounted_cash": 40.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.61, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPID PANEL", "code_information": [{"code": "80061", "type": "CPT"}, {"code": "1000224", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.4, "maximum": 44.82, "gross_charge": 49.8, "discounted_cash": 54.17, "estimated_discounted_cash": 49.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 39.84, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 44.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 28.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPID PANEL DOC REV", "code_information": [{"code": "3011F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIPITOR (ATORVASTATIN CAL) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000485", "type": "CDM"}, {"code": "00904629061", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIPITOR (ATORVASTATIN CAL) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000289", "type": "CDM"}, {"code": "00904629261", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIPOPRO BLD ELECTROPHORETIC", "code_information": [{"code": "83700", "type": "CPT"}], "standard_charges": [{"minimum": 12.95, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN (a)", "code_information": [{"code": "83695", "type": "CPT"}, {"code": "1000931", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.47, "maximum": 64.8, "gross_charge": 72.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BLD HR FRACTION", "code_information": [{"code": "83701", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BLD QUAN PART", "code_information": [{"code": "83704", "type": "CPT"}], "standard_charges": [{"minimum": 39.32, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIPOPRTN DIR MEAS SD LDL CHL", "code_information": [{"code": "83722", "type": "CPT"}], "standard_charges": [{"minimum": 39.32, "maximum": 39.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LISOCABTAGENE MARA CAR POS T", "code_information": [{"code": "Q2054", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LISTERIA MONOCYTOGENES", "code_information": [{"code": "86723", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LITH ION NON PROSTH RECHARGE", "code_information": [{"code": "A4601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LITHIUM", "code_information": [{"code": "80178", "type": "CPT"}, {"code": "1000182", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.6, "maximum": 35.2, "gross_charge": 39.12, "discounted_cash": 54.17, "estimated_discounted_cash": 39.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM CARBONATE ER TAB 450MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000760", "type": "CDM"}, {"code": "51079014220", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LITHIUM CARBONATE TAB 150MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000979", "type": "CDM"}, {"code": "00054852625", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LITT ICR 1 TRAJ 1 SMPL LES", "code_information": [{"code": "61736", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LITT ICR MLT TRJ MLT/CPLX LS", "code_information": [{"code": "61737", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LITTLE SUCKER, SUCTION", "code_information": [{"code": "3001453", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LIVER & SPLEEN IMAGE/FLOW", "code_information": [{"code": "78216", "type": "CPT"}], "standard_charges": [{"minimum": 160.72, "maximum": 160.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 160.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER AND SPLEEN IMAGING", "code_information": [{"code": "78215", "type": "CPT"}], "standard_charges": [{"minimum": 233.73, "maximum": 233.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 233.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER DIS 10 ASSAYS W/ASH", "code_information": [{"code": "2M", "type": "CPT"}], "standard_charges": [{"minimum": 26.51, "maximum": 26.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER DIS 10 ASSAYS W/NASH", "code_information": [{"code": "3M", "type": "CPT"}], "standard_charges": [{"minimum": 26.51, "maximum": 26.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER DS 10 BIOCHEM ASY SRM", "code_information": [{"code": "166U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER DS ALYS 3 BMRK SRM ALG", "code_information": [{"code": "81517", "type": "CPT"}], "standard_charges": [{"minimum": 202.62, "maximum": 202.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 202.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER ELASTOGRAPHY", "code_information": [{"code": "91200", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING", "code_information": [{"code": "78201", "type": "CPT"}], "standard_charges": [{"minimum": 226.83, "maximum": 226.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 226.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING WITH FLOW", "code_information": [{"code": "78202", "type": "CPT"}], "standard_charges": [{"minimum": 251.26, "maximum": 251.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 251.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER KIDNEY MICROSOMAL ANTIBOSY", "code_information": [{"code": "86376", "type": "CPT"}, {"code": "1000530", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.73, "maximum": 103.37, "gross_charge": 86.13, "discounted_cash": 54.17, "estimated_discounted_cash": 86.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.9, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [{"code": "5", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [{"code": "6", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LMTD OPH EXAM GENERAL ANES", "code_information": [{"code": "92019", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LNGVTY&MRTLTY RSK MRNA 18GEN", "code_information": [{"code": "294U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LO FREQ US DIATHERMY DEVICE", "code_information": [{"code": "K1004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOBAR LUNG TRANSPLANTATION", "code_information": [{"code": "S2060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOCAL ANESTHESIA", "code_information": [{"code": "D9215", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.72, "maximum": 112.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [{"code": "496", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC", "code_information": [{"code": "495", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "497", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC", "code_information": [{"code": "498", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "499", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LOCALIZED DELIVERY ANTIMICRO", "code_information": [{"code": "D4381", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOCK PROTECTIVE NEEDLE", "code_information": [{"code": "3000228", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOCM 100-199MG/ML IODINE,1ML", "code_information": [{"code": "Q9965", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOCM 200-299MG/ML IODINE,1ML", "code_information": [{"code": "Q9966", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOCM >= 400 MG/ML IODINE,1ML", "code_information": [{"code": "Q9951", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LODGING COSTS (E.G. HOTEL CH", "code_information": [{"code": "S9994", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LODGING PER DIEM", "code_information": [{"code": "S9976", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LODINE (ETODOLAC) TAB 400MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000228", "type": "CDM"}, {"code": "51672401801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOKELMA (SOD. ZIRCONIUM CYC 10GM/1PKT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003578", "type": "CDM"}, {"code": "00310111030", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 71.01, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOMOTIL (DIPHENOXYL/ATROP) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000162", "type": "CDM"}, {"code": "69315091001", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOMUSTINE 10 MG", "code_information": [{"code": "S0178", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LONG ACT INHAL BRONCHDIL PRE", "code_information": [{"code": "G9695", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LONG INHAL BRONCHDIL NO PRES", "code_information": [{"code": "G9699", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOPID (GEMFIBROZIL) TAB 600MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000208", "type": "CDM"}, {"code": "50268035015", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOPRESSOR (METOPROLOL TART) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000351", "type": "CDM"}, {"code": "51079025520", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOPRESSOR (METOPROLOL TART) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000130", "type": "CDM"}, {"code": "51079080120", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOPRESSOR (METOPROLOL) 5MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "7000315", "type": "CDM"}, {"code": "00409201610", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 30.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOTENSIN (BENAZEPRIL HCL) 20MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000477", "type": "CDM"}, {"code": "50268011115", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOTENSIN (BENAZEPRIL) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000176", "type": "CDM"}, {"code": "65862011601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOTENSIN (BENAZEPRIL) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000273", "type": "CDM"}, {"code": "23155075201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOTENSIN/HCTZ 20MG-12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001028", "type": "CDM"}, {"code": "00574022901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOTREL (AMLOD BES/BENAZEP) CAP 10/40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000517", "type": "CDM"}, {"code": "65862058701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOTREL (AMLOD BES/BENAZEP) CAP 5/10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000181", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOTRIMIN (CLOTRIMAZOLE) 1% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000120", "type": "CDM"}, {"code": "00168025815", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 8.97, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOTRISONE (CLOTRIM/BETAMETH) 1% CREAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003899", "type": "CDM"}, {"code": "00168025815", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 42.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOTRONEX (ALOSETRON) 1MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004348", "type": "CDM"}, {"code": "70756070130", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 30.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOUDNESS BALANCE TEST", "code_information": [{"code": "92562", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOVAZA LIQ CAP 1GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000923", "type": "CDM"}, {"code": "54868581600", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LOVENOX (ENOXAPARIN) INJ 100 MG/ML", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "7000296", "type": "CDM"}, {"code": "00781326869", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 22.8, "maximum": 36.0, "gross_charge": 40.0, "discounted_cash": 54.17, "estimated_discounted_cash": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOVENOX (ENOXAPARIN) INJ 30 MG/0.3ML", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "72000204", "type": "CDM"}, {"code": "25021041070", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 27.58, "maximum": 43.56, "gross_charge": 48.4, "discounted_cash": 54.17, "estimated_discounted_cash": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 43.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOVENOX (ENOXAPARIN) INJ 40 MG/0.4ML", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "7000298", "type": "CDM"}, {"code": "00781324602", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 13.64, "maximum": 21.54, "gross_charge": 23.94, "discounted_cash": 54.17, "estimated_discounted_cash": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 19.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 21.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOVENOX (ENOXAPARIN) INJ 60 MG/0.6ML", "drug_information": {"unit": 6.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "7000299", "type": "CDM"}, {"code": "00781325666", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 55.26, "maximum": 87.25, "gross_charge": 96.95, "discounted_cash": 54.17, "estimated_discounted_cash": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 72.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 87.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOVENOX (ENOXAPARIN) INJ 80 MG/0.8ML", "drug_information": {"unit": 8.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "7000300", "type": "CDM"}, {"code": "63323053190", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 73.67, "maximum": 116.32, "gross_charge": 129.25, "discounted_cash": 54.17, "estimated_discounted_cash": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 96.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 103.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 116.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW BACK DISK SURGERY", "code_information": [{"code": "63030", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5271", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5272", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5276", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5277", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5278", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW DENSITY LIPOPROTEIN(LDL)", "code_information": [{"code": "S2120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW EXTEMITY NEUR EXAM DOCUM", "code_information": [{"code": "G8404", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW EXTEMITY NEUR NOT PERFOR", "code_information": [{"code": "G8405", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW FREQUENCY NON-THERMAL US", "code_information": [{"code": "97610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW NTSTY ESWT CORPUS CVRNSM", "code_information": [{"code": "864T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW PECARN PED HEAD TRAUMA", "code_information": [{"code": "G9593", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW RECUR PROST CA", "code_information": [{"code": "G9706", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW RISK FOR RETINOPATHY", "code_information": [{"code": "3072F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW RISK PROSTATE CANCER", "code_information": [{"code": "3271F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW RSK THROMBOEMBOLISM", "code_information": [{"code": "3550F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER THERAPY", "code_information": [{"code": "552T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER TRMT 15 MIN", "code_information": [{"code": "S8948", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [{"code": "493", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [{"code": "492", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "494", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY ORTHOSIS NOS", "code_information": [{"code": "L2999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOWER JAW BONE GRAFT", "code_information": [{"code": "21215", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOWR EXTREMITY PROSTHES NOS", "code_information": [{"code": "L5999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOXAPINE FOR INHALATION 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2062", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LPN CARE EA 15MIN HH/HOSPICE", "code_information": [{"code": "G0494", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LPN CARE TRAIN/EDU IN HH", "code_information": [{"code": "G0496", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LPN HOME CARE PER DIEM", "code_information": [{"code": "T1031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LPN/LVN SERVICES UP TO 15MIN", "code_information": [{"code": "T1003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LPOPRTN BLD W/5 MAJ CLASSES", "code_information": [{"code": "52U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS 250 G OR LESS", "code_information": [{"code": "58541", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS ABOVE 250 G", "code_information": [{"code": "58543", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UT 250 G OR LESS", "code_information": [{"code": "58542", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UTERUS ABOVE 250 G", "code_information": [{"code": "58544", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LU GNOTYP BCAM EXON 3", "code_information": [{"code": "196U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUMBAR PUNCTURE KIT ADULT", "code_information": [{"code": "3000522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.56, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LUMBAR PUNCTURE KIT INFANT", "code_information": [{"code": "3000597", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LUMBAR ROLL", "code_information": [{"code": "3000229", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LUMIGAN OPTH 0.01%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000395", "type": "CDM"}, {"code": "00023320505", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 1544.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LUMIZYME INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNESTA (ESZOPICLONE) TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000398", "type": "CDM"}, {"code": "55111062930", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LUNG BX PLUG W/DEL SYS", "code_information": [{"code": "C2613", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG CX BX RPT NO DOC CLASS", "code_information": [{"code": "G9421", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG FUNCTION TEST (MBC/MVV)", "code_information": [{"code": "94200", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG PERF&VENTILAT DIFERENTL", "code_information": [{"code": "78598", "type": "CPT"}], "standard_charges": [{"minimum": 361.35, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 361.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION DIFFERENTIAL", "code_information": [{"code": "78597", "type": "CPT"}], "standard_charges": [{"minimum": 240.9, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 240.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION IMAGING", "code_information": [{"code": "78580", "type": "CPT"}], "standard_charges": [{"minimum": 281.95, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 281.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT", "code_information": [{"code": "7", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT DOUBLE", "code_information": [{"code": "32853", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT SINGLE", "code_information": [{"code": "32851", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32852", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32854", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILAT&PERFUS IMAGING", "code_information": [{"code": "78582", "type": "CPT"}], "standard_charges": [{"minimum": 396.12, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 396.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILATION IMAGING", "code_information": [{"code": "78579", "type": "CPT"}], "standard_charges": [{"minimum": 222.53, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 222.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG VOLUME REDUCTION", "code_information": [{"code": "32491", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNGCX BX RPT DOCS CLASS", "code_information": [{"code": "G9418", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUPUS ANTICOAGULANT COMPREHENSIVE", "code_information": [{"code": "85597", "type": "CPT"}, {"code": "1000335", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.68, "maximum": 95.76, "gross_charge": 106.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.12, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 95.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUTEINIZING HORMONE", "code_information": [{"code": "83002", "type": "CPT"}, {"code": "1000677", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.3, "maximum": 103.37, "gross_charge": 109.62, "discounted_cash": 54.17, "estimated_discounted_cash": 109.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUTETIUM LU 177 DOTATAT THER", "code_information": [{"code": "A9513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUTETIUM LU 177 VIPIVOTIDE", "code_information": [{"code": "A9607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF <= 40% OR LVSD", "code_information": [{"code": "G8923", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF <=40%", "code_information": [{"code": "G8694", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF <=40% OR DEP LV SYS FCN", "code_information": [{"code": "G8934", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF <=40% OR MOD/SEV L VSF", "code_information": [{"code": "M1150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF >=40% SYSTOLIC", "code_information": [{"code": "3022F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF ASSESS PLANPOST DSCHRGE", "code_information": [{"code": "3019F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF GREATER THAN 35%", "code_information": [{"code": "3056F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF LESS THAN/EQUAL TO 35%", "code_information": [{"code": "3055F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF MOD/SEVER DEPRS SYST", "code_information": [{"code": "3021F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF NOT PERFORMED", "code_information": [{"code": "G8396", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVEF>=40% DOC NORMAL OR MILD", "code_information": [{"code": "G8395", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LVF ASSESS", "code_information": [{"code": "3020F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LW GNOTYP ICAM4 EXON 1", "code_information": [{"code": "197U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LWR XTR VASC STDY BILAT", "code_information": [{"code": "93924", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYME ANTIBODY TOTAL", "code_information": [{"code": "86618", "type": "CPT"}, {"code": "1000253", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.58, "maximum": 96.7, "gross_charge": 94.71, "discounted_cash": 54.17, "estimated_discounted_cash": 94.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 75.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 85.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 53.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA AMP PROBE", "code_information": [{"code": "87476", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA DIR PROBE", "code_information": [{"code": "87475", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE ANTIBODY", "code_information": [{"code": "86617", "type": "CPT"}], "standard_charges": [{"minimum": 17.81, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH CHORIOMENINGITIS AB", "code_information": [{"code": "86727", "type": "CPT"}], "standard_charges": [{"minimum": 14.8, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH SYSTEM IMAGING", "code_information": [{"code": "78195", "type": "CPT"}], "standard_charges": [{"minimum": 422.12, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 422.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARM/LEG", "code_information": [{"code": "75801", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 679.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 679.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARMS/LEGS", "code_information": [{"code": "75803", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 1741.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1741.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75805", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 3518.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3518.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75807", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 3521.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3521.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTE CULTURE MIXED", "code_information": [{"code": "86821", "type": "CPT"}], "standard_charges": [{"minimum": 42.04, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTE IMMUNE GLOBULIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7504", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTE TRANSFORMATION", "code_information": [{"code": "86353", "type": "CPT"}], "standard_charges": [{"minimum": 56.38, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 56.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTOTOXICITY ASSAY", "code_information": [{"code": "86805", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 217.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 217.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTOTOXICITY ASSAY", "code_information": [{"code": "86806", "type": "CPT"}], "standard_charges": [{"minimum": 54.73, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "821", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "820", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "822", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "841", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "840", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [{"code": "824", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [{"code": "823", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "825", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "842", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "LYRICA (PREGABALIN) 150MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001513", "type": "CDM"}, {"code": "00904700261", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LYRICA (PREGABALIN) 25MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002892", "type": "CDM"}, {"code": "60687047301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LYRICA (PREGABALIN) CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000445", "type": "CDM"}, {"code": "69238131309", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LYRICA (PREGABALIN) CAP 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000166", "type": "CDM"}, {"code": "00071101368", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LYRICA (PREGABALIN) CAP 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000315", "type": "CDM"}, {"code": "69238131209", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LYRICA (PREGABALIN) SOLUTION 20MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001038", "type": "CDM"}, {"code": "00071102001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN INIT DAY", "code_information": [{"code": "32561", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN SUBQ DAY", "code_information": [{"code": "32562", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYSIS + LAVAGE W CATHETERS", "code_information": [{"code": "D7871", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYSIS INTRANASAL SYNECHIA", "code_information": [{"code": "30560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYSIS OF LABIAL LESION(S)", "code_information": [{"code": "56441", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYSIS PENIL CIRCUMIC LESION", "code_information": [{"code": "54162", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LYSOL DISINFECTANT SPRAY", "code_information": [{"code": "80001247", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LYUMJEV FOR INSULIN PUMP USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1813", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lanthanum carbonate, oral, 5 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to J0607 (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Low-density lipoprotein receptor-related protein 4 (LRP4), antibody identification by immunofluorescence, using live cells, reported as positive or negative", "code_information": [{"code": "546U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lower extremity fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed", "code_information": [{"code": "64474", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed", "code_information": [{"code": "64473", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lower respiratory tract infectious agent detection, 18 bacteria, 8 viruses, and 7 antimicrobial-resistance genes, amplified probe technique, including reverse transcription for RNA targets, each analyte reported as detected or not detected with semiquanti", "code_information": [{"code": "528U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lung expansion airway clearance, continuous high frequency oscillation, and nebulization device", "code_information": [{"code": "E0469", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M. GENITALIUM AMP PROBE", "code_information": [{"code": "87563", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 40.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA AMP PROB", "code_information": [{"code": "87561", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA DIR PROB", "code_information": [{"code": "87560", "type": "CPT"}], "standard_charges": [{"minimum": 31.38, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA QUANT", "code_information": [{"code": "87562", "type": "CPT"}], "standard_charges": [{"minimum": 49.27, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA AMP PROBE", "code_information": [{"code": "87581", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA DIR PROBE", "code_information": [{"code": "87580", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA QUANT", "code_information": [{"code": "87582", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 348.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 348.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA AMP PROBE", "code_information": [{"code": "87556", "type": "CPT"}], "standard_charges": [{"minimum": 47.93, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 47.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA DIR PROBE", "code_information": [{"code": "87555", "type": "CPT"}], "standard_charges": [{"minimum": 30.91, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA QUANT", "code_information": [{"code": "87557", "type": "CPT"}], "standard_charges": [{"minimum": 49.27, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS ISHQUANT/SEMIQ", "code_information": [{"code": "88373", "type": "CPT"}], "standard_charges": [{"minimum": 74.34, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS ISHQUANT/SEMIQ", "code_information": [{"code": "88374", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 343.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 343.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS ISHQUANT/SEMIQ", "code_information": [{"code": "88377", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 426.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 426.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS SKELETAL MUSC", "code_information": [{"code": "88355", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 154.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 154.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYSISHQUANT/SEMIQ", "code_information": [{"code": "88369", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 122.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 122.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAC PGMT OPT DNS MEAS HFP", "code_information": [{"code": "506T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MACROBID (NITRO/MONO/MACRO) CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000129", "type": "CDM"}, {"code": "70756040411", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MACRODANTIN (NITROFU/MACRO) CAP 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000337", "type": "CDM"}, {"code": "51079058401", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MACRODANTIN (NITROFURAN. MACRO) CAP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001068", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 16.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MACROSCOPIC EXAM PARASITE", "code_information": [{"code": "87169", "type": "CPT"}], "standard_charges": [{"minimum": 4.96, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MACUL RESULT PHY/QHP MNG DM", "code_information": [{"code": "5010F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAG 64MG (SLOW MAG) TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000427", "type": "CDM"}, {"code": "68585000575", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MAG CTRLD CAPSULE ENDOSCOPY", "code_information": [{"code": "651T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAG OX (MAGNESIUM OXIDE) TAB 400MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000301", "type": "CDM"}, {"code": "10006070028", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MAG-TAB SR 84MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004465", "type": "CDM"}, {"code": "59016042016", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MAGIC MOUTH WASH (BEN/MYL/CARA) LIQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000184", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MAGNESIUM", "code_information": [{"code": "83735", "type": "CPT"}, {"code": "1000183", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.71, "maximum": 35.69, "gross_charge": 39.66, "discounted_cash": 54.17, "estimated_discounted_cash": 39.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNESIUM 24HR UR", "code_information": [{"code": "83735", "type": "CPT"}, {"code": "1000344", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.71, "maximum": 35.69, "gross_charge": 39.66, "discounted_cash": 54.17, "estimated_discounted_cash": 39.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNESIUM CITRATE ORAL SOLN 10OZ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000112", "type": "CDM"}, {"code": "71399788901", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MAGNESIUM GLUCONATE 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004322", "type": "CDM"}, {"code": "60258017201", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.92, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MAGNESIUM SULF 50% 5GM/10 ML INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J3475", "type": "HCPCS"}, {"code": "7200078", "type": "CDM"}, {"code": "51754100004", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 28.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE BONE MARROW", "code_information": [{"code": "77084", "type": "CPT"}], "standard_charges": [{"minimum": 432.33, "maximum": 432.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 432.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE JAW JOINT", "code_information": [{"code": "70336", "type": "CPT"}], "standard_charges": [{"minimum": 402.19, "maximum": 812.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 402.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAGNETIC SOURCE IMAGING", "code_information": [{"code": "S8035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAIN HEMO IN-CNTR", "code_information": [{"code": "G0049", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAIN/CLEAN MAX PROSTHESIS", "code_information": [{"code": "D5993", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.19, "maximum": 185.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 185.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "654", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [{"code": "653", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "655", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [{"code": "164", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [{"code": "163", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "165", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [{"code": "184", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [{"code": "183", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "185", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [{"code": "369", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [{"code": "368", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "370", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [{"code": "372", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 2493.06, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [{"code": "371", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "373", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [{"code": "141", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [{"code": "140", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "142", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [{"code": "809", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [{"code": "808", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "810", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [{"code": "469", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC", "code_information": [{"code": "470", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [{"code": "483", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITH CC/MCC", "code_information": [{"code": "707", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "708", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "507", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "508", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "595", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "596", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "330", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "329", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "331", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [{"code": "506", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33750", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33755", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33762", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33766", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33767", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT & GRAFT", "code_information": [{"code": "33764", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAKENA, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1726", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MALARIA ANTIBODY", "code_information": [{"code": "86750", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MALE CONDOM", "code_information": [{"code": "A4267", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MALE SLING PROCEDURE", "code_information": [{"code": "53440", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MALE VACUUM ERECTION SYSTEM", "code_information": [{"code": "L7900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MALIG TUMOR > 1.25 CM", "code_information": [{"code": "D7441", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MALIG TUMOR EXC TO 1.25 CM", "code_information": [{"code": "D7440", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [{"code": "436", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [{"code": "435", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC", "code_information": [{"code": "437", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "755", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "754", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "756", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "723", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "722", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "724", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [{"code": "598", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [{"code": "597", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "599", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MAMMO ASSESS BENGN DOCD", "code_information": [{"code": "3342F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAMMO ASSESS CAT IN DBASE", "code_information": [{"code": "7020F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAMMO ASSESS HGHLYMALIG DOC", "code_information": [{"code": "3345F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAMMO ASSESS INC XRAY DOCD", "code_information": [{"code": "3340F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAMMO ASSESS NEGATIVE DOCD", "code_information": [{"code": "3341F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAMMO ASSESS SUSP DOCD", "code_information": [{"code": "3344F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAMMO BX PROVEN MALIG DOCD", "code_information": [{"code": "3350F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAMMO PROBABLY BENGN DOCD", "code_information": [{"code": "3343F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAMMO RESULT COM TO PT 5 DAY", "code_information": [{"code": "5062F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANDIBLE GRAFT", "code_information": [{"code": "D7950", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR DENTURE PROSTH", "code_information": [{"code": "D5935", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR FLANGE PROSTHESIS", "code_information": [{"code": "D5934", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR PART DENTURE FLEX", "code_information": [{"code": "D5226", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANICURE STICKS", "code_information": [{"code": "3000230", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MANIPULAT PALM CORD POST INJ", "code_information": [{"code": "26341", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANIPULATE FINGER W/ANESTH", "code_information": [{"code": "26340", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANIPULATE WRIST W/ANESTHES", "code_information": [{"code": "25259", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF HIP JOINT", "code_information": [{"code": "27275", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF SPINE", "code_information": [{"code": "22505", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANNITOL FOR INHALER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7665", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANUAL CELL COUNT EACH", "code_information": [{"code": "85032", "type": "CPT"}], "standard_charges": [{"minimum": 4.96, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANUAL DIFF WBC COUNT B-COAT", "code_information": [{"code": "85009", "type": "CPT"}], "standard_charges": [{"minimum": 5.83, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANUAL PUMP ENEMA, REUSABLE", "code_information": [{"code": "A4459", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANUAL RETICULOCYTE COUNT", "code_information": [{"code": "85044", "type": "CPT"}], "standard_charges": [{"minimum": 4.96, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANUAL STANDING SYSTEM", "code_information": [{"code": "E2230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MANUAL THERAPY 1/> REGIONS", "code_information": [{"code": "97140", "type": "CPT"}], "standard_charges": [{"minimum": 25.75, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 113.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAP TACHYCARDIA ADD-ON", "code_information": [{"code": "93609", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO COMMUNITY", "code_information": [{"code": "G9152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO PHYSICIAN", "code_information": [{"code": "G9153", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO STATE", "code_information": [{"code": "G9151", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPLE SYRUP UR DS MNTR QUAN", "code_information": [{"code": "381U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MARCAINE (BUPIVACAINE) 0.25% INJ", "drug_information": {"unit": 150.0, "type": "EA"}, "code_information": [{"code": "J0665", "type": "HCPCS"}, {"code": "72000926", "type": "CDM"}, {"code": "00409115902", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARCAINE (BUPIVACAINE) 0.5% INJ", "drug_information": {"unit": 300.0, "type": "EA"}, "code_information": [{"code": "J0665", "type": "HCPCS"}, {"code": "7000305", "type": "CDM"}, {"code": "00409156029", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARINOL (NF-DRONABINOL) CAP 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000761", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 14.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MARINOL (NF-DRONABINOL) Cap 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "Q0167", "type": "HCPCS"}, {"code": "7002615", "type": "CDM"}, {"code": "67877075460", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.29, "maximum": 14.67, "gross_charge": 16.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 13.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION ODON CYST", "code_information": [{"code": "D7509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASK FACE SURGICAL", "code_information": [{"code": "3000523", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MASK ISOLATION", "code_information": [{"code": "3000231", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MASK MULTIVENT", "code_information": [{"code": "3000233", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MASK TRACHEOSTOMY", "code_information": [{"code": "3000238", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MASS SPECTROMETRY QUAL/QUAN", "code_information": [{"code": "83789", "type": "CPT"}], "standard_charges": [{"minimum": 27.73, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASSAGE THERAPY", "code_information": [{"code": "97124", "type": "CPT"}], "standard_charges": [{"minimum": 27.84, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAST MOD RAD", "code_information": [{"code": "19307", "type": "CPT"}], "standard_charges": [{"minimum": 21736.36, "maximum": 21736.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 21736.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAST RADICAL", "code_information": [{"code": "19305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAST SIMPLE COMPLETE", "code_information": [{"code": "19303", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "582", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "583", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MASTERS TWO STEP", "code_information": [{"code": "S3904", "type": "HCPCS"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69601", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69602", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69603", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69604", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69501", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69502", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTOTOMY EXPL DRG ABSC DP", "code_information": [{"code": "19020", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MATRION 1 SQ CM", "code_information": [{"code": "Q4201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MATRISTEM MICROMATRIX", "code_information": [{"code": "Q4118", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MATRL FOR VOCAL CORD", "code_information": [{"code": "C1878", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAX MRI CAPTURE & INTERPRETE", "code_information": [{"code": "D0369", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAX MRI IMAGE CAPTURE", "code_information": [{"code": "D0385", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAX STERILE BARRIERS FLWD", "code_information": [{"code": "6030F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAX ULTRASOUND CAPT & INTERP", "code_information": [{"code": "D0370", "type": "HCPCS"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAX ULTRASOUND IMAGE CAPTURE", "code_information": [{"code": "D0386", "type": "HCPCS"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAXILLA OPEN REDUCT COMPOUND", "code_information": [{"code": "D7710", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAXILLA OPEN REDUCT SIMPLE", "code_information": [{"code": "D7610", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAXILLA OR MANDIBLE RESECTIO", "code_information": [{"code": "D7490", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAXILLARY PART DENTURE FLEX", "code_information": [{"code": "D5225", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAXILLARY SINUSOTOMY", "code_information": [{"code": "D7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAXILLOFACIAL FIXATION", "code_information": [{"code": "21100", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAXILLOFACIAL PROSTHESIS", "code_information": [{"code": "D5999", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAXIPIME (CEFEPIME) 1GM INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0692", "type": "HCPCS"}, {"code": "72000103", "type": "CDM"}, {"code": "60505614404", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXIPIME 1GM/100ML 0.9% NS", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0692", "type": "HCPCS"}, {"code": "72000799", "type": "CDM"}, {"code": "60505614604", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXZIDE (NF-TRIAMT/HCTZ) 37.5MG-25MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000924", "type": "CDM"}, {"code": "68084075025", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MCCD, HOME MONITORING", "code_information": [{"code": "G9006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, INITIAL RATE", "code_information": [{"code": "G9001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ HI, INITIAL", "code_information": [{"code": "G9003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ LO, INITIAL", "code_information": [{"code": "G9004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 3", "code_information": [{"code": "G9009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 4", "code_information": [{"code": "G9010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 5", "code_information": [{"code": "G9011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, MAINTENANCE", "code_information": [{"code": "G9005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, SCH TEAM CONF", "code_information": [{"code": "G9007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD,MAINTENANCE RATE", "code_information": [{"code": "G9002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD,PHYS COOR-CARE OVRSGHT", "code_information": [{"code": "G9008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCHNL FRAGILITY RBC PRFLG", "code_information": [{"code": "123U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCOLN1 GENE", "code_information": [{"code": "81290", "type": "CPT"}], "standard_charges": [{"minimum": 45.21, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY DX", "code_information": [{"code": "29900", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29901", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29902", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD CERTIFICATION HHA PATIENT", "code_information": [{"code": "G0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD DOCUMENT VISIT BY NPP", "code_information": [{"code": "G0454", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD HOME VISIT OUTSIDE CAP", "code_information": [{"code": "S0273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD INR TEST REVIE INTER MGMT", "code_information": [{"code": "G0250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD RECERTIFICATION HHA PT", "code_information": [{"code": "G0179", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD SERVICE REQUIRED FOR PMD", "code_information": [{"code": "G0372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD/OTH EVAL ACUT KID NO ESRD", "code_information": [{"code": "G0492", "type": "HCPCS"}], "standard_charges": [{"minimum": 2442.42, "maximum": 2442.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2442.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MDD IN REMISSION", "code_information": [{"code": "3092F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MDD MILD", "code_information": [{"code": "3088F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MDD MODERATE", "code_information": [{"code": "3089F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MDD SEVERE W/O PSYCH", "code_information": [{"code": "3090F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MDD SEVERE W/PSYCH", "code_information": [{"code": "3091F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MDFC FLAP W/PRSRV VASC PEDCL", "code_information": [{"code": "15730", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEALS FOR CLINICAL TRIAL PAR", "code_information": [{"code": "S9996", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEALS PER DIEM", "code_information": [{"code": "S9977", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEALS WHEN RECEIVE SERVICES", "code_information": [{"code": "T1010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEAS LUNG VOL THRU 2 YRS", "code_information": [{"code": "94013", "type": "CPT"}], "standard_charges": [{"minimum": 326.52, "maximum": 326.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 326.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEASLES/MUMPS/RUBELLA IMMUNITY", "code_information": [{"code": "86735", "type": "CPT"}, {"code": "1000484", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.01, "maximum": 69.52, "gross_charge": 77.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 69.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE KIDNEY PRESSURE", "code_information": [{"code": "50396", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEASURE URETER PRESSURE", "code_information": [{"code": "50686", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEASURE VENOUS PRESSURE", "code_information": [{"code": "93770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECASERMIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2170", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECH ALLERGEN PARTI BARRIER", "code_information": [{"code": "A7023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36595", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36596", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECHANICAL CHEST WALL OSCILL", "code_information": [{"code": "94669", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECHANICAL TRACTION THERAPY", "code_information": [{"code": "97012", "type": "CPT"}], "standard_charges": [{"minimum": 13.61, "maximum": 103.18, "discounted_cash": 54.17, "estimated_discounted_cash": 56.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECHLORETHAMINE HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9230", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECKELS DIVERT EXAM", "code_information": [{"code": "78290", "type": "CPT"}], "standard_charges": [{"minimum": 390.76, "maximum": 390.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 390.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECP2 FULL GENE ANALYSIS", "code_information": [{"code": "234U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE DUP/DELET VARIANT", "code_information": [{"code": "81304", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 172.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 172.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE FULL SEQ", "code_information": [{"code": "81302", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 607.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 607.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE KNOWN VARIANT", "code_information": [{"code": "81303", "type": "CPT"}], "standard_charges": [{"minimum": 138.0, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 138.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED ABORTION INC ALL EX DRUG", "code_information": [{"code": "S0199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED ADMIN, NOT ORAL/INJECT", "code_information": [{"code": "T1503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX BUPRE ORAL", "code_information": [{"code": "G2068", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX INJECT", "code_information": [{"code": "G2069", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX METH WK", "code_information": [{"code": "G2067", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX NO DRUG", "code_information": [{"code": "G2074", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED DOC RSN NO ACE ARN ARNI", "code_information": [{"code": "G2093", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED DOC RSN NO LOW EX", "code_information": [{"code": "G2179", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED FOOD NON INBORN ERR META", "code_information": [{"code": "S9432", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED LIST DOCD IN RCRD", "code_information": [{"code": "1159F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED NUTRITION INDIV SUBSEQ", "code_information": [{"code": "97803", "type": "CPT"}], "standard_charges": [{"minimum": 627.29, "maximum": 627.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 627.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED PHYSIC DOS EVAL RAD EXPS", "code_information": [{"code": "76145", "type": "CPT"}], "standard_charges": [{"minimum": 999.44, "maximum": 999.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 999.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED REAS NO PERF FOOT EXAM", "code_information": [{"code": "G9502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED REAS NOT INCL HISTO TYPE", "code_information": [{"code": "G9419", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED REAS PT, PN, NOT DOC", "code_information": [{"code": "G8722", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED REAS RPT NO HISTO TYPE", "code_information": [{"code": "G9423", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RECORD COPY ADMIN", "code_information": [{"code": "S9981", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RECORD COPY PER PAGE", "code_information": [{"code": "S9982", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED REMINDER SERV PER MONTH", "code_information": [{"code": "S5185", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RISK PROSTATE CANCER", "code_information": [{"code": "3272F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RSN FOR NO DOC SPIRO", "code_information": [{"code": "M1215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RSN NO ACE-I/ARB RX", "code_information": [{"code": "M1201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RSN NO IMP/CON MMR/MSI", "code_information": [{"code": "M1194", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RSN NO PRESC BRONCHDIL", "code_information": [{"code": "G9696", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RSN NO RPT BLADDER INJ", "code_information": [{"code": "G9626", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RSN NO RPT BOWEL INJ", "code_information": [{"code": "G9629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RSN SYS ANTIMI NT RX", "code_information": [{"code": "G9960", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED SERV 10PM-8AM 24 HR FAC", "code_information": [{"code": "99053", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED SERV EVE/WKEND/HOLIDAY", "code_information": [{"code": "99051", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED SERVICE OUT OF OFFICE", "code_information": [{"code": "99056", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED TRNG & SUPPORT PER 15MIN", "code_information": [{"code": "H0034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED TX MEDS NOS", "code_information": [{"code": "G2075", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED TX NALTREXONE", "code_information": [{"code": "G2073", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED TXMNT OPTIONS RVWD W/PT", "code_information": [{"code": "4325F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/LMPH NOD BX", "code_information": [{"code": "39402", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/MEDSTNL BX", "code_information": [{"code": "39401", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [{"code": "551", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [{"code": "552", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MEDICAL CONFERENCE BY PHYSIC", "code_information": [{"code": "S0220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL CONFERENCE, 60 MIN", "code_information": [{"code": "S0221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL FOOD ORAL 100% NUTR", "code_information": [{"code": "S9433", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL FOODS FOR INBORN ERR", "code_information": [{"code": "S9435", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL 1", "code_information": [{"code": "G9148", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL II", "code_information": [{"code": "G9149", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL III", "code_information": [{"code": "G9150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME, INITIAL PLAN", "code_information": [{"code": "S0280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME, MAINTENANCE", "code_information": [{"code": "S0281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL NUTRITION GROUP", "code_information": [{"code": "97804", "type": "CPT"}], "standard_charges": [{"minimum": 627.29, "maximum": 627.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 627.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL NUTRITION INDIV IN", "code_information": [{"code": "97802", "type": "CPT"}], "standard_charges": [{"minimum": 627.29, "maximum": 627.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 627.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL REASON FOR NO BETA", "code_information": [{"code": "G9190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL SERVICES AFTER HRS", "code_information": [{"code": "99050", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL SUPPLIES AND EQUIPME", "code_information": [{"code": "S9061", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL TESTIMONY", "code_information": [{"code": "99075", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICATION ADMIN VISIT", "code_information": [{"code": "T1502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDISKIN", "code_information": [{"code": "Q4135", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDROL DOSE PACK 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001033", "type": "CDM"}, {"code": "42806040021", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEDROXYPROGESTERONE ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDRSN >1 SINUS CT W 90D DX", "code_information": [{"code": "G9353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDRSN NO PT CATEGORY", "code_information": [{"code": "G9292", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEG EVOKED EACH ADDL", "code_information": [{"code": "95967", "type": "CPT"}], "standard_charges": [{"minimum": 7955.52, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEG EVOKED SINGLE", "code_information": [{"code": "95966", "type": "CPT"}], "standard_charges": [{"minimum": 7955.52, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEG SPONTANEOUS", "code_information": [{"code": "95965", "type": "CPT"}], "standard_charges": [{"minimum": 7955.52, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEGACE (MEGESTROL ACETATE) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000308", "type": "CDM"}, {"code": "00555060702", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEGACE (MEGESTROL) SUS 40MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000277", "type": "CDM"}, {"code": "64380016002", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEGESTROL 20 MG", "code_information": [{"code": "S0179", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MELAN FOLLOW-UP COMPLETE", "code_information": [{"code": "15F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MELANOMAAJCC STAGE 0 OR IA", "code_information": [{"code": "3322F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MELATONIN 1MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001148", "type": "CDM"}, {"code": "74312002832", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MELATONIN 3MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001053", "type": "CDM"}, {"code": "77333051610", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MELATONIN 5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001034", "type": "CDM"}, {"code": "20555003901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MELPHALAN ORAL 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEMBRANE GRAFT OR WRAP SQ CM", "code_information": [{"code": "Q4205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEMBRANE WRAP HYDR PER SQ CM", "code_information": [{"code": "Q4290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEMODERM/DERMA/TRANZ/INTEGUP", "code_information": [{"code": "Q4126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEMOREX DVD+R DISC", "code_information": [{"code": "80000918", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MENACWY-TT MENB-FHBP VACC IM", "code_information": [{"code": "90623", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENACWY-TT VACCINE IM", "code_information": [{"code": "90619", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENACWYD/MENACWYCRM VACC IM", "code_information": [{"code": "90734", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENB-4C VACC 2 DOSE IM", "code_information": [{"code": "90620", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENB-FHBP VACC 2/3 DOSE IM", "code_information": [{"code": "90621", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENISCAL TRNSPL KNEE W/SCPE", "code_information": [{"code": "29868", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENS SHOES HIGHTOP DEPTH INL", "code_information": [{"code": "L3222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC", "code_information": [{"code": "760", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "761", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MENTAL HEALTH SERVICE, NOS", "code_information": [{"code": "H0046", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENTAL STATUS ASSESS", "code_information": [{"code": "2014F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE HYDROCHL /100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE/PROMETHAZINE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEPILEX BORDER DRESSING 3.5X10", "code_information": [{"code": "3001395", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 70.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER DRESSING 3X3", "code_information": [{"code": "3001367", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER DRESSING 4X4", "code_information": [{"code": "3001401", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.54, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER DRESSING 4X8", "code_information": [{"code": "3001420", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER DRESSING 6X6", "code_information": [{"code": "3001438", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER SACRUM 7.2 X7.2", "code_information": [{"code": "3001417", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 143.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEPILEX FOAM DRESSING 4X4", "code_information": [{"code": "3001473", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEPILEX FOAM DRESSING 6X6", "code_information": [{"code": "3001372", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MEPILEX LITE FOAM DRESSING 6X6", "code_information": [{"code": "3001397", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MERCAPTOPURINE 50 MG", "code_information": [{"code": "S0108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MERCURY BLOOD", "code_information": [{"code": "83825", "type": "CPT"}, {"code": "1000184", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.7, "maximum": 86.61, "gross_charge": 96.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 76.99, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 86.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 54.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MERREM (MEROPENEM) 1 GM/100ML NS", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J2185", "type": "HCPCS"}, {"code": "72000403", "type": "CDM"}, {"code": "70594007602", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 66.12, "maximum": 104.4, "gross_charge": 116.0, "discounted_cash": 54.17, "estimated_discounted_cash": 116.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 104.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 66.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESALAMINE DR 400MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001147", "type": "CDM"}, {"code": "60687055632", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MESH (IMPLANTABLE)", "code_information": [{"code": "C1781", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MESIAL/DISTAL WEDGE PROC", "code_information": [{"code": "D4274", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MESNA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MESTINON (PYRIDOSTIGMINE BROM) 60MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004333", "type": "CDM"}, {"code": "62559047001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "METABOLIC PANEL IONIZED CA", "code_information": [{"code": "80047", "type": "CPT"}], "standard_charges": [{"minimum": 26.51, "maximum": 26.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METAL / METALLOIDS HAIR", "code_information": [{"code": "82175", "type": "CPT"}, {"code": "1000976", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.82, "maximum": 101.06, "gross_charge": 112.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 89.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METAMUCIL (PSYLLIUM) 0.4GM CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001153", "type": "CDM"}, {"code": "37000040514", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "METAMUCIL (PSYLLIUM) POWDER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000310", "type": "CDM"}, {"code": "37000074087", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "METANEPHRINE FRAC PLASMA FREE", "code_information": [{"code": "83835", "type": "CPT"}, {"code": "1000557", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.48, "maximum": 103.37, "gross_charge": 100.29, "discounted_cash": 54.17, "estimated_discounted_cash": 100.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.23, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METANEPHRINE FRACTIONATED 24HR UR QUANT", "code_information": [{"code": "83835", "type": "CPT"}, {"code": "1000347", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.48, "maximum": 103.37, "gross_charge": 100.29, "discounted_cash": 54.17, "estimated_discounted_cash": 100.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.23, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METANEPHRINES, PHEOCHROMOCYTOMA EVAL, UR", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "1000644", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 27.56, "gross_charge": 30.63, "discounted_cash": 54.17, "estimated_discounted_cash": 23.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METAPROTERENOL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7667", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METAPROTERENOL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METAPROTERENOL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7668", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METAPROTERENOL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7669", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METERED DOSE INHALER DRUG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHACHOLINE CHLORIDE, NEB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7674", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHADONE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHADONE ORAL 5MG", "code_information": [{"code": "S0109", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHADONE, SERUM", "code_information": [{"code": "80358", "type": "CPT"}, {"code": "1000805", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 70.57, "gross_charge": 78.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHICILLIN RESISTANT STAPH AUREUS SCREE", "code_information": [{"code": "87081", "type": "CPT"}, {"code": "1000348", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.62, "maximum": 35.34, "gross_charge": 39.27, "discounted_cash": 54.17, "estimated_discounted_cash": 39.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHOCARBAMOL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2800", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHOTREXATE", "code_information": [{"code": "80299", "type": "CPT"}, {"code": "1000919", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 21.44, "maximum": 98.1, "gross_charge": 109.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHOTREXATE ORAL 2.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHOTREXATE SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHOTREXATE TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000633", "type": "CDM"}, {"code": "51079067005", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "METHYL AMINOLEVULINATE, TOP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7309", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHYLDOPATE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0210", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHYLENE BLUE 1% 10MG/1ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200053", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "METHYLENEDIOXYAMPHETAMINES", "code_information": [{"code": "80359", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHYLERGONOVIN MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHYLMALONIC ACID SERUM", "code_information": [{"code": "83921", "type": "CPT"}, {"code": "1000487", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.39, "maximum": 87.69, "gross_charge": 97.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.95, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 87.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLPHENIDATE", "code_information": [{"code": "80360", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHYLPREDNISOLONE ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METYRAPONE PANEL", "code_information": [{"code": "80436", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 104.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 104.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEVACOR (LOVASTATIN) 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000435", "type": "CDM"}, {"code": "68180046801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MGMT GENE PRMTR MTHYLTN ALYS", "code_information": [{"code": "81287", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 143.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 143.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MH CLUBHOUSE SVC, PER 15 MIN", "code_information": [{"code": "H2030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MH CLUBHOUSE SVC, PER DIEM", "code_information": [{"code": "H2031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MH HEALTH ASSESS BY NON-MD", "code_information": [{"code": "H0031", "type": "HCPCS"}], "standard_charges": [{"minimum": 838.62, "maximum": 838.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 838.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MH PARTIAL HOSP TX UNDER 24H", "code_information": [{"code": "H0035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MH SVC PLAN DEV BY NON-MD", "code_information": [{"code": "H0032", "type": "HCPCS"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIBM BUT NO DX OF BREAST CA", "code_information": [{"code": "G8946", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICARDIS (TELMISARITAN) 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000396", "type": "CDM"}, {"code": "00378292193", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MICARDIS (TELMISART/HCTZ) TAB 80/12.5", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000177", "type": "CDM"}, {"code": "00597004437", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 9.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MICARDIS (TELMISARTAN) 80MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001156", "type": "CDM"}, {"code": "00378292293", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MICARDIS 40MG/12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000779", "type": "CDM"}, {"code": "00597004337", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MICRO EXAM, PREP & REPORT", "code_information": [{"code": "D0473", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICRO W EXAM OF SURG MARGINS", "code_information": [{"code": "D0474", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROALBUMIN 24HR UR", "code_information": [{"code": "82043", "type": "CPT"}, {"code": "1000346", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.65, "maximum": 40.5, "gross_charge": 45.0, "discounted_cash": 54.17, "estimated_discounted_cash": 17.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPT MACROBROTH", "code_information": [{"code": "87188", "type": "CPT"}], "standard_charges": [{"minimum": 7.64, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPT MYCOBACTERI", "code_information": [{"code": "87190", "type": "CPT"}], "standard_charges": [{"minimum": 8.41, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE DIFFUSE", "code_information": [{"code": "87181", "type": "CPT"}], "standard_charges": [{"minimum": 5.46, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE DISK", "code_information": [{"code": "87184", "type": "CPT"}], "standard_charges": [{"minimum": 8.6, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE ENZYME", "code_information": [{"code": "87185", "type": "CPT"}], "standard_charges": [{"minimum": 5.46, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE MIC", "code_information": [{"code": "87186", "type": "CPT"}], "standard_charges": [{"minimum": 9.95, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE MLC", "code_information": [{"code": "87187", "type": "CPT"}], "standard_charges": [{"minimum": 23.08, "maximum": 46.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROCAPILLARY TUBE SEALANT", "code_information": [{"code": "A4652", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICRODISSECTION LASER", "code_information": [{"code": "88380", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 136.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 136.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICRODISSECTION MANUAL", "code_information": [{"code": "88381", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 220.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 220.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROFLUID ANALY TEARS", "code_information": [{"code": "83861", "type": "CPT"}], "standard_charges": [{"minimum": 25.85, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROLYTE MATRIX, PER SQ CM", "code_information": [{"code": "A2005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROSATELLITE INSTABILITY", "code_information": [{"code": "81301", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 400.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 400.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROSCOPIC EXAM OF URINE", "code_information": [{"code": "81015", "type": "CPT"}], "standard_charges": [{"minimum": 3.51, "maximum": 8.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROSURG EPI SPERM ASP", "code_information": [{"code": "S4028", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROSURGERY ADD-ON", "code_information": [{"code": "69990", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROVOLT T-WAVE ASSESS", "code_information": [{"code": "93025", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICROWAVE BRONCH, 3D, EBUS", "code_information": [{"code": "C9751", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIDDLE CEREBRAL ARTERY ECHO", "code_information": [{"code": "76821", "type": "CPT"}], "standard_charges": [{"minimum": 113.65, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 113.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIFEPRISTONE, ORAL, 200 MG", "code_information": [{"code": "S0190", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MILD-MOD DEP SYMP BY DEPTOOL", "code_information": [{"code": "3353F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MILK AND MOLASSES ENEMA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000457", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MILK OF MAGNESIA 30ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000319", "type": "CDM"}, {"code": "57896064916", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MINERAL OIL 30CC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200088", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2206", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MINOCYCLINE HCL CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000627", "type": "CDM"}, {"code": "00904688806", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MINOCYCLINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "663", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [{"code": "662", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "664", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MINOR BLUNT TRAUMA W/HEAD CT", "code_information": [{"code": "G9529", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "606", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "607", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "345", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "344", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "346", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MINOXIDIL TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000188", "type": "CDM"}, {"code": "49884025701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MINOXIDIL, 10 MG", "code_information": [{"code": "S0139", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIRACLE MOUTH WASH (LIDO/BEN/MYL)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000189", "type": "CDM"}, {"code": "00054350049", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MIRACLE MOUTHWASH 5 ML", "code_information": [{"code": "7200089", "type": "CDM"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MIRALAX (POLYETHYLENE GLYCOL) 17GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000320", "type": "CDM"}, {"code": "00536105227", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MIRAPEX (NF-MIRAPEX) TAB 1.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001267", "type": "CDM"}, {"code": "13668009590", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MIRAPEX (PRAMIPEXOLE) TAB 0.125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000595", "type": "CDM"}, {"code": "13668009190", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 9.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MIRAPEX (PRAMIPEXOLE) TAB 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004314", "type": "CDM"}, {"code": "13668009290", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MIRAPEX (PRAMIPEXOLE) TAB 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000987", "type": "CDM"}, {"code": "13668009490", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MIRENA, 52 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7298", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIRO3D PER CUBIC CM", "code_information": [{"code": "A2025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIRODERM", "code_information": [{"code": "Q4175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIRRAGEN ADV WND MAT PER SQ", "code_information": [{"code": "A2002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIRROR COATING", "code_information": [{"code": "V2761", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIS SUP/AC IMP VAD NOPAY MED", "code_information": [{"code": "Q0509", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIS SUP/ACC IMP VAD", "code_information": [{"code": "Q0508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISC DIALYSIS SUPPLIES NOC", "code_information": [{"code": "A4913", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISC INTEGRAL LENS SERV", "code_information": [{"code": "S0590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISC SMEAR CYTOLOGY", "code_information": [{"code": "88161", "type": "CPT"}, {"code": "1000567", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 30.71, "maximum": 114.3, "gross_charge": 127.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 101.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 114.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MISC SUP/ACC EXT VAD", "code_information": [{"code": "Q0507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISC USED WITH TOT ART HEART", "code_information": [{"code": "L8698", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISC VISION ITEM OR SERVICE", "code_information": [{"code": "V2799", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISC/EXPER NON-PRESCRIPT DRU", "code_information": [{"code": "A9150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [{"code": "640", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 6759.44, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [{"code": "641", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 2627.72, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MISOPROSTOL, ORAL, 200 MCG", "code_information": [{"code": "S0191", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISSED APPOINTMENT", "code_information": [{"code": "D9986", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MISSING HB A1C LEVEL", "code_information": [{"code": "M1212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIT STEN, VALVE OR TRANS AF", "code_information": [{"code": "G9746", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MITOCHONDRIAL ANTIBODY (M2)", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000244", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MITOCHONDRIAL ANTIBODY EACH", "code_information": [{"code": "86381", "type": "CPT"}], "standard_charges": [{"minimum": 29.27, "maximum": 29.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MITOCHONDRIAL GENE", "code_information": [{"code": "81440", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 3822.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3822.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MITOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9280", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MITOMYCIN INSTILLATION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MITOXANTRONE HYDROCHL / 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9293", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLG COMPLET, PER SQ CM", "code_information": [{"code": "Q4256", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE", "code_information": [{"code": "81288", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 221.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 221.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81294", "type": "CPT"}], "standard_charges": [{"minimum": 232.76, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 232.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE FULL SEQ", "code_information": [{"code": "81292", "type": "CPT"}], "standard_charges": [{"minimum": 776.71, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 776.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE KNOWN VARIANTS", "code_information": [{"code": "81293", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 380.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLH1 MRNA SEQ ALYS", "code_information": [{"code": "158U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLT FAM GRP BHV TRAIN 1ST 60", "code_information": [{"code": "96202", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLT FAM GRP BHV TRAIN EA ADD", "code_information": [{"code": "96203", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MM BI DIAGNOSTIC 2D 3D", "code_information": [{"code": "77066", "type": "CPT"}, {"code": "2400019", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 161.54, "maximum": 429.7, "gross_charge": 477.45, "discounted_cash": 54.17, "estimated_discounted_cash": 477.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 202.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 381.96, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 429.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 272.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MM BI DIAGNOSTIC DIGITAL", "code_information": [{"code": "77066", "type": "CPT"}, {"code": "2400014", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 161.54, "maximum": 403.2, "gross_charge": 448.0, "discounted_cash": 54.17, "estimated_discounted_cash": 477.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 202.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 255.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MM BI SCREENING", "code_information": [{"code": "77067", "type": "CPT"}, {"code": "2400004", "type": "CDM"}, {"code": "403", "type": "RC"}], "standard_charges": [{"minimum": 71.25, "maximum": 162.94, "gross_charge": 125.0, "discounted_cash": 54.17, "estimated_discounted_cash": 399.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 162.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MM BI SCREENING 2D 3D", "code_information": [{"code": "77067", "type": "CPT"}, {"code": "2400017", "type": "CDM"}, {"code": "403", "type": "RC"}], "standard_charges": [{"minimum": 161.54, "maximum": 360.82, "gross_charge": 400.92, "discounted_cash": 54.17, "estimated_discounted_cash": 399.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 162.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 320.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 360.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 228.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MM BI SCREENING DIGITAL", "code_information": [{"code": "77067", "type": "CPT"}, {"code": "2400013", "type": "CDM"}, {"code": "403", "type": "RC"}], "standard_charges": [{"minimum": 161.54, "maximum": 360.82, "gross_charge": 400.92, "discounted_cash": 54.17, "estimated_discounted_cash": 399.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 162.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 320.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 360.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 228.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MM UNI DIAG DIGITAL 2D 3D", "code_information": [{"code": "77065", "type": "CPT"}, {"code": "2400018", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 160.3, "maximum": 364.41, "gross_charge": 404.91, "discounted_cash": 54.17, "estimated_discounted_cash": 342.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 323.92, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 364.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 230.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MM UNI DIAG LT DIGITAL", "code_information": [{"code": "2400015", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"gross_charge": 385.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MM UNI DIAG RT", "code_information": [{"code": "2400003", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MM UNI DIAG RT DIGITAL", "code_information": [{"code": "2400016", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"gross_charge": 385.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MMR VACCINE SC", "code_information": [{"code": "90707", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MMRV VACCINE SC", "code_information": [{"code": "90710", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ DP RX DLVR DEV", "code_information": [{"code": "20700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ I-ARTIC RX DEV", "code_information": [{"code": "20704", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ IMED RX DEV", "code_information": [{"code": "20702", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNPJ ANES SHO JT FIXJ APRATS", "code_information": [{"code": "23700", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNPJ ELBOW UNDER ANES", "code_information": [{"code": "24300", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNPJ OF TMJ W/ANESTH", "code_information": [{"code": "21073", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNT SUBS TX FOR CHANGE DX", "code_information": [{"code": "G0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 627.29, "maximum": 627.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 627.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTAL/BEHAV/PSYCH HLTH SS", "code_information": [{"code": "G4013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG 1ST 2 HRS", "code_information": [{"code": "495T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG EA ADDL HR", "code_information": [{"code": "496T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR IO PRESS 24HRS/> UNI/BI", "code_information": [{"code": "329T", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR PSYCHDLC MED 1STPHY/QHP", "code_information": [{"code": "820T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR PSYCHDLC MED 2NDPHY/QHP", "code_information": [{"code": "821T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR PSYCHDLC MED CLN STAFF", "code_information": [{"code": "822T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOBIC (MELOXICAM) TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000336", "type": "CDM"}, {"code": "60687019901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOBIC (MELOXICAM) TAB 7.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000140", "type": "CDM"}, {"code": "50268052515", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOBILIZATION OF COLON", "code_information": [{"code": "44139", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOBILIZE ERUPTED/MALPOS TOOT", "code_information": [{"code": "D7282", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOD OR SEVERE OSA", "code_information": [{"code": "G8846", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP 5/>YRS INITIAL15MIN", "code_information": [{"code": "99156", "type": "CPT"}, {"code": "11000309", "type": "CDM"}, {"code": "372", "type": "RC"}], "standard_charges": [{"minimum": 76.29, "maximum": 214.38, "gross_charge": 238.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 178.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 190.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 214.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 135.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP <5YR INITIAL15MIN", "code_information": [{"code": "99155", "type": "CPT"}, {"code": "11000310", "type": "CDM"}, {"code": "372", "type": "RC"}], "standard_charges": [{"minimum": 76.29, "maximum": 234.71, "gross_charge": 260.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 195.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 208.63, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 234.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 148.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP EACH ADDL 15 MIN", "code_information": [{"code": "99157", "type": "CPT"}, {"code": "11000311", "type": "CDM"}, {"code": "372", "type": "RC"}], "standard_charges": [{"minimum": 76.29, "maximum": 174.42, "gross_charge": 193.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 155.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 174.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 110.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHY/QHP 5/>YRS INITIAL15MIN", "code_information": [{"code": "99152", "type": "CPT"}, {"code": "11000409", "type": "CDM"}, {"code": "372", "type": "RC"}], "standard_charges": [{"minimum": 76.29, "maximum": 182.52, "gross_charge": 202.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 152.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 162.24, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 182.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 115.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP <5YR INITIAL15MIN", "code_information": [{"code": "99151", "type": "CPT"}, {"code": "11000410", "type": "CDM"}, {"code": "372", "type": "RC"}], "standard_charges": [{"minimum": 76.29, "maximum": 215.43, "gross_charge": 239.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 191.49, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 215.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 136.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP EACH ADDL 15 MIN", "code_information": [{"code": "99153", "type": "CPT"}, {"code": "11000411", "type": "CDM"}, {"code": "372", "type": "RC"}], "standard_charges": [{"minimum": 27.15, "maximum": 76.29, "gross_charge": 47.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 35.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 38.11, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 42.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SEDAT ENDO SERVICE >5YRS", "code_information": [{"code": "G0500", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOD SOLID FOOD SUPPL", "code_information": [{"code": "S9434", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MODERNA VACC ADMIN 1ST DOSE", "code_information": [{"code": "D1703", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MODERNA VACC ADMIN 2ND DOSE", "code_information": [{"code": "D1704", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MODERNA VACC ADMIN 3RD DOSE", "code_information": [{"code": "D1710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MODERNA VACC ADMIN BOOSTER", "code_information": [{"code": "D1711", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MODIFICATION OF CONTACT LENS", "code_information": [{"code": "92325", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MODIFY SPEECH AID PROSTHESIS", "code_information": [{"code": "D5960", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB CBA EACH", "code_information": [{"code": "86362", "type": "CPT"}], "standard_charges": [{"minimum": 13.86, "maximum": 13.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86363", "type": "CPT"}], "standard_charges": [{"minimum": 13.86, "maximum": 13.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE H/N/HF/G", "code_information": [{"code": "17311", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE T/A/L", "code_information": [{"code": "17313", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE", "code_information": [{"code": "17312", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE T/A/L", "code_information": [{"code": "17314", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOHS SURG ADDL BLOCK", "code_information": [{"code": "17315", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOL DIAG READER SELF-ADMN", "code_information": [{"code": "K1035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOLEC FLUOR IMG SUS NEV 1ST", "code_information": [{"code": "700T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOLEC FLUOR IMG SUS NEV EA", "code_information": [{"code": "701T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATHOLOGY INTERPR", "code_information": [{"code": "G0452", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOLECULAR TEST PUB HLTH PATH", "code_information": [{"code": "D0606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOMETASONE SINUS SINUVA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MON ANESTH CARE", "code_information": [{"code": "G9654", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MONISTAT (MICONAZOLE NITR) CREAM 2%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000621", "type": "CDM"}, {"code": "51672203506", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 98.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MONISTAT (MICONAZOLE) 3 KIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000589", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 24.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MONIT STORE CRYO EMBRYO 30 D", "code_information": [{"code": "S4040", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MONITORING FEATURE/DEVICENOC", "code_information": [{"code": "A9279", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MONO TEST", "code_information": [{"code": "86308", "type": "CPT"}, {"code": "1000112", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 33.38, "gross_charge": 30.63, "discounted_cash": 54.17, "estimated_discounted_cash": 30.63, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONOCLONAL ANTIBODIES", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7505", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MONOCYTE DSTRBJ WDTH WHL BLD", "code_information": [{"code": "427U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MONOKET (ISOSORBIDE MONO) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001805", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MONOKET (ISOSORBIDE MONO) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000635", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MONONUCLEAR CELL ANTIGEN", "code_information": [{"code": "86356", "type": "CPT"}], "standard_charges": [{"minimum": 30.8, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MONOPRIL (FOSINOPRIL SOD) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000319", "type": "CDM"}, {"code": "69097085605", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MONOPRIL (FOSINOPRIL SOD) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000322", "type": "CDM"}, {"code": "69097085705", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MONOVISC INJ PER DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7327", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MONTGOMERY STRAP", "code_information": [{"code": "3000240", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 1", "code_information": [{"code": "81400", "type": "CPT"}], "standard_charges": [{"minimum": 73.55, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 73.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 2", "code_information": [{"code": "81401", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 3", "code_information": [{"code": "81402", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 172.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 172.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 4", "code_information": [{"code": "81403", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 5", "code_information": [{"code": "81404", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 316.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 6", "code_information": [{"code": "81405", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 346.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 346.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 7", "code_information": [{"code": "81406", "type": "CPT"}], "standard_charges": [{"minimum": 325.31, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 325.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 8", "code_information": [{"code": "81407", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 973.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 973.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 9", "code_information": [{"code": "81408", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 2300.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2300.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MORCELLATOR", "code_information": [{"code": "C1782", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MORGAN MEDI-FLOW LENS", "code_information": [{"code": "3001309", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 86.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MORPHINE 500 MG", "code_information": [{"code": "S0093", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MORPHINE SULFATE 10MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2270", "type": "HCPCS"}, {"code": "72000537", "type": "CDM"}, {"code": "00641612725", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MORPHINE SULFATE 2MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2272", "type": "HCPCS"}, {"code": "72001082", "type": "CDM"}, {"code": "63323045201", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MORPHINE SULFATE 4MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2272", "type": "HCPCS"}, {"code": "72001083", "type": "CDM"}, {"code": "63323045401", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MORPHINE SULFATE IR TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000813", "type": "CDM"}, {"code": "00054023525", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.57, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MORPHINE SULFATE ORAL SOL 10MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000498", "type": "CDM"}, {"code": "00054023763", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MORPHINE SULFATE ORAL SOL 20MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000995", "type": "CDM"}, {"code": "00054040450", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOST RCT BP </= 140/90", "code_information": [{"code": "G9788", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOST RCT BP >/= 140/90", "code_information": [{"code": "G9790", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOST RCT TOB STAT FREE", "code_information": [{"code": "G9791", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOST RCT TOB STAT NOT FREE", "code_information": [{"code": "G9792", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOST RECENT ASSESS VOL MGMT", "code_information": [{"code": "G8955", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOST, per square centimeter", "code_information": [{"code": "Q4328", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOTION ANALYSIS VIDEO/3D", "code_information": [{"code": "96000", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOTION FLUOROSCOPY/SWALLOW", "code_information": [{"code": "92611", "type": "CPT"}], "standard_charges": [{"minimum": 182.71, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOTION TEST W/FT PRESS MEAS", "code_information": [{"code": "96001", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOTOR &/ SENS NRVE CNDJ TEST", "code_information": [{"code": "95905", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOTR COG VR GAIT TRAIN EA 15", "code_information": [{"code": "791T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOTRIN (IBUPROFEN) SUSP 100MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000100", "type": "CDM"}, {"code": "45802013326", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOTRIN (IBUPROFEN) TAB 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000733", "type": "CDM"}, {"code": "00904791461", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOTRIN (IBUPROFEN) TAB 400MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000239", "type": "CDM"}, {"code": "00904585361", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOTRIN (IBUPROFEN) TAB 600MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000240", "type": "CDM"}, {"code": "60687045701", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOUTH CARE SAGE KIT", "code_information": [{"code": "3000241", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOUTH PROCEDURES WITH CC/MCC", "code_information": [{"code": "137", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MOUTH PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "138", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MOUTHWASH ACTIFRESH", "code_information": [{"code": "3000121", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MOVANTIK 25MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001006", "type": "CDM"}, {"code": "82625880201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 37.47, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MPL GENE COMMON VARIANTS", "code_information": [{"code": "81338", "type": "CPT"}], "standard_charges": [{"minimum": 172.88, "maximum": 172.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 172.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MPL GENE SEQ ALYS EXON 10", "code_information": [{"code": "81339", "type": "CPT"}], "standard_charges": [{"minimum": 212.98, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MPM USED", "code_information": [{"code": "G2148", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MPSV4 VACCINE SUBQ", "code_information": [{"code": "90733", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANG LWR EXT W OR W/O DYE", "code_information": [{"code": "73725", "type": "CPT"}], "standard_charges": [{"minimum": 503.74, "maximum": 503.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 503.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIO PELVIS W/O & W/DYE", "code_information": [{"code": "72198", "type": "CPT"}], "standard_charges": [{"minimum": 505.49, "maximum": 505.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 505.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIO SPINE W/O&W/DYE", "code_information": [{"code": "72159", "type": "CPT"}], "standard_charges": [{"minimum": 519.5, "maximum": 519.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 519.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIO UPR EXTR W/O&W/DYE", "code_information": [{"code": "73225", "type": "CPT"}], "standard_charges": [{"minimum": 514.89, "maximum": 514.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 514.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIOGRAPH HEAD W/O&W/DYE", "code_information": [{"code": "70546", "type": "CPT"}], "standard_charges": [{"minimum": 491.44, "maximum": 491.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 491.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIOGRAPH NECK W/O&W/DYE", "code_information": [{"code": "70549", "type": "CPT"}], "standard_charges": [{"minimum": 516.7, "maximum": 516.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 516.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIOGRAPHY HEAD W/DYE", "code_information": [{"code": "70545", "type": "CPT"}], "standard_charges": [{"minimum": 339.8, "maximum": 339.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 339.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIOGRAPHY HEAD W/O DYE", "code_information": [{"code": "70544", "type": "CPT"}], "standard_charges": [{"minimum": 322.52, "maximum": 322.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 322.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIOGRAPHY NECK W/DYE", "code_information": [{"code": "70548", "type": "CPT"}], "standard_charges": [{"minimum": 369.15, "maximum": 369.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 369.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ANGIOGRAPHY NECK W/O DYE", "code_information": [{"code": "70547", "type": "CPT"}], "standard_charges": [{"minimum": 323.45, "maximum": 323.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 323.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR ELASTOGRAPHY", "code_information": [{"code": "76391", "type": "CPT"}], "standard_charges": [{"minimum": 270.13, "maximum": 270.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 270.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR SPECTROSCOPY", "code_information": [{"code": "76390", "type": "CPT"}], "standard_charges": [{"minimum": 550.24, "maximum": 550.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 550.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR safety determination by a physician or other qualified health care professional responsible for the safety of the MR procedure, including review of implant MR conditions for indicated MR examination, analysis of risk vs clinical benefit of performing M", "code_information": [{"code": "76016", "type": "CPT"}], "standard_charges": [{"minimum": 86.27, "maximum": 86.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 86.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review o", "code_information": [{"code": "76014", "type": "CPT"}], "standard_charges": [{"minimum": 12.39, "maximum": 12.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review o", "code_information": [{"code": "76015", "type": "CPT"}], "standard_charges": [{"minimum": 59.69, "maximum": 59.69, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR safety implant electronics preparation under supervision of physician or other qualified health care professional, including MR-specific programming of pulse generator and/or transmitter to verify device integrity, protection of device internal circuit", "code_information": [{"code": "76018", "type": "CPT"}], "standard_charges": [{"minimum": 134.7, "maximum": 134.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 134.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR safety implant positioning and/or immobilization under supervision of physician or other qualified health care professional, including application of physical protections to secure implanted medical device from MR-induced translational or vibrational f", "code_information": [{"code": "76019", "type": "CPT"}], "standard_charges": [{"minimum": 173.42, "maximum": 173.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 173.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR safety medical physics examination customization, planning and performance monitoring by medical physicist or MR safety expert, with review and analysis by physician or other qualified health care professional to prioritize and select views and imaging", "code_information": [{"code": "76017", "type": "CPT"}], "standard_charges": [{"minimum": 260.6, "maximum": 260.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 260.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MR-STAPH DNA AMP PROBE", "code_information": [{"code": "87641", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, ABD", "code_information": [{"code": "C8900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, CHEST", "code_information": [{"code": "C8909", "type": "HCPCS"}], "standard_charges": [{"minimum": 1593.51, "maximum": 1593.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1593.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, LWR EXT", "code_information": [{"code": "C8912", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, PELVIS", "code_information": [{"code": "C8918", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, ABD", "code_information": [{"code": "C8901", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, CHEST", "code_information": [{"code": "C8910", "type": "HCPCS"}], "standard_charges": [{"minimum": 1593.51, "maximum": 1593.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1593.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, LWR EXT", "code_information": [{"code": "C8913", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, PELVIS", "code_information": [{"code": "C8919", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, ABD", "code_information": [{"code": "C8902", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, CHEST", "code_information": [{"code": "C8911", "type": "HCPCS"}], "standard_charges": [{"minimum": 1593.51, "maximum": 1593.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1593.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, LWR EXT", "code_information": [{"code": "C8914", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, PELVIS", "code_information": [{"code": "C8920", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA, W/DYE, SPINAL CANAL", "code_information": [{"code": "C8931", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA, W/DYE, UPPER EXTREMITY", "code_information": [{"code": "C8934", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA, W/O DYE, SPINAL CANAL", "code_information": [{"code": "C8932", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA, W/O DYE, UPPER EXTR", "code_information": [{"code": "C8935", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA, W/O&W/DYE, SPINAL CANAL", "code_information": [{"code": "C8933", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRA, W/O&W/DYE, UPPER EXTR", "code_information": [{"code": "C8936", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRCP", "code_information": [{"code": "S8037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRGFUS STRTCTC LES ABLTJ", "code_information": [{"code": "406U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN W/DYE", "code_information": [{"code": "74182", "type": "CPT"}], "standard_charges": [{"minimum": 457.4, "maximum": 457.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 457.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN W/O & W/DYE", "code_information": [{"code": "74183", "type": "CPT"}], "standard_charges": [{"minimum": 513.0, "maximum": 513.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 513.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN W/O DYE", "code_information": [{"code": "74181", "type": "CPT"}], "standard_charges": [{"minimum": 296.02, "maximum": 296.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 296.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI ANGIO ABDOM W ORW/O DYE", "code_information": [{"code": "74185", "type": "CPT"}], "standard_charges": [{"minimum": 506.42, "maximum": 506.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 506.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI ANGIO CHEST W OR W/O DYE", "code_information": [{"code": "71555", "type": "CPT"}], "standard_charges": [{"minimum": 503.21, "maximum": 1593.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 503.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1593.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN STEM W/DYE", "code_information": [{"code": "70552", "type": "CPT"}], "standard_charges": [{"minimum": 406.78, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 406.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN STEM W/O & W/DYE", "code_information": [{"code": "70553", "type": "CPT"}], "standard_charges": [{"minimum": 481.32, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 481.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN STEM W/O DYE", "code_information": [{"code": "70551", "type": "CPT"}], "standard_charges": [{"minimum": 295.23, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 295.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/DYE", "code_information": [{"code": "70558", "type": "CPT"}], "standard_charges": [{"minimum": 328.17, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 328.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/O & W/DYE", "code_information": [{"code": "70559", "type": "CPT"}], "standard_charges": [{"minimum": 315.28, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 315.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/O DYE", "code_information": [{"code": "70557", "type": "CPT"}], "standard_charges": [{"minimum": 749.77, "maximum": 7955.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 749.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7955.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C- BILATERAL", "code_information": [{"code": "77047", "type": "CPT"}], "standard_charges": [{"minimum": 294.36, "maximum": 294.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 294.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C- UNILATERAL", "code_information": [{"code": "77046", "type": "CPT"}], "standard_charges": [{"minimum": 286.11, "maximum": 286.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 286.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C-+ W/CAD BI", "code_information": [{"code": "77049", "type": "CPT"}], "standard_charges": [{"minimum": 461.94, "maximum": 461.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 461.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C-+ W/CAD UNI", "code_information": [{"code": "77048", "type": "CPT"}], "standard_charges": [{"minimum": 451.75, "maximum": 451.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 451.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI CHEST SPINE W/DYE", "code_information": [{"code": "72147", "type": "CPT"}], "standard_charges": [{"minimum": 411.92, "maximum": 411.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 411.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI CHEST SPINE W/O & W/DYE", "code_information": [{"code": "72157", "type": "CPT"}], "standard_charges": [{"minimum": 484.55, "maximum": 484.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 484.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI CHEST SPINE W/O DYE", "code_information": [{"code": "72146", "type": "CPT"}], "standard_charges": [{"minimum": 288.22, "maximum": 288.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 288.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI CHEST W/DYE", "code_information": [{"code": "71551", "type": "CPT"}], "standard_charges": [{"minimum": 567.2, "maximum": 1424.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 567.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1424.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI CHEST W/O & W/DYE", "code_information": [{"code": "71552", "type": "CPT"}], "standard_charges": [{"minimum": 669.37, "maximum": 1424.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1424.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI CHEST W/O DYE", "code_information": [{"code": "71550", "type": "CPT"}], "standard_charges": [{"minimum": 422.18, "maximum": 1424.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 422.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1424.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI CT SCAN ORD RVWD RQSTD", "code_information": [{"code": "3324F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI FETAL EA ADDL GESTATION", "code_information": [{"code": "74713", "type": "CPT"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 303.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI FETAL SNGL/1ST GESTATION", "code_information": [{"code": "74712", "type": "CPT"}], "standard_charges": [{"minimum": 531.75, "maximum": 531.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 531.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI GDN PARNCHYMA TISS ABLTJ", "code_information": [{"code": "77022", "type": "CPT"}], "standard_charges": [{"minimum": 809.06, "maximum": 922.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 922.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 809.06, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI GUIDANCE NDL PLMT RS&I", "code_information": [{"code": "77021", "type": "CPT"}], "standard_charges": [{"minimum": 608.25, "maximum": 809.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 809.06, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI HYPERPOLARIZED XENON129", "code_information": [{"code": "C9791", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI JNT OF LWR EXTRE W/O DYE", "code_information": [{"code": "73721", "type": "CPT"}], "standard_charges": [{"minimum": 303.8, "maximum": 812.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 303.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI JOINT LWR EXTR W/O&W/DYE", "code_information": [{"code": "73723", "type": "CPT"}], "standard_charges": [{"minimum": 587.44, "maximum": 812.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 587.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI JOINT OF LWR EXTR W/DYE", "code_information": [{"code": "73722", "type": "CPT"}], "standard_charges": [{"minimum": 476.37, "maximum": 812.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 476.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI JOINT UPR EXTR W/O&W/DYE", "code_information": [{"code": "73223", "type": "CPT"}], "standard_charges": [{"minimum": 589.31, "maximum": 812.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 589.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI JOINT UPR EXTREM W/DYE", "code_information": [{"code": "73222", "type": "CPT"}], "standard_charges": [{"minimum": 475.43, "maximum": 812.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 475.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI JOINT UPR EXTREM W/O DYE", "code_information": [{"code": "73221", "type": "CPT"}], "standard_charges": [{"minimum": 304.27, "maximum": 812.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 304.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI LOW FIELD", "code_information": [{"code": "S8042", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTREMITY W/DYE", "code_information": [{"code": "73719", "type": "CPT"}], "standard_charges": [{"minimum": 397.43, "maximum": 397.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 397.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTREMITY W/O DYE", "code_information": [{"code": "73718", "type": "CPT"}], "standard_charges": [{"minimum": 337.42, "maximum": 337.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 337.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI LUMBAR SPINE W/DYE", "code_information": [{"code": "72149", "type": "CPT"}], "standard_charges": [{"minimum": 408.65, "maximum": 408.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 408.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI LUMBAR SPINE W/O & W/DYE", "code_information": [{"code": "72158", "type": "CPT"}], "standard_charges": [{"minimum": 482.69, "maximum": 482.69, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 482.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI LUMBAR SPINE W/O DYE", "code_information": [{"code": "72148", "type": "CPT"}], "standard_charges": [{"minimum": 289.15, "maximum": 289.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 289.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI LWR EXTREMITY W/O&W/DYE", "code_information": [{"code": "73720", "type": "CPT"}], "standard_charges": [{"minimum": 511.77, "maximum": 511.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 511.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI NECK SPINE W/DYE", "code_information": [{"code": "72142", "type": "CPT"}], "standard_charges": [{"minimum": 416.12, "maximum": 416.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 416.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI NECK SPINE W/O & W/DYE", "code_information": [{"code": "72156", "type": "CPT"}], "standard_charges": [{"minimum": 484.09, "maximum": 484.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 484.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI NECK SPINE W/O DYE", "code_information": [{"code": "72141", "type": "CPT"}], "standard_charges": [{"minimum": 288.69, "maximum": 288.69, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 288.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI ORBIT/FACE/NECK W/DYE", "code_information": [{"code": "70542", "type": "CPT"}], "standard_charges": [{"minimum": 405.82, "maximum": 405.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 405.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI ORBIT/FACE/NECK W/O DYE", "code_information": [{"code": "70540", "type": "CPT"}], "standard_charges": [{"minimum": 341.62, "maximum": 341.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 341.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI ORBT/FAC/NCK W/O &W/DYE", "code_information": [{"code": "70543", "type": "CPT"}], "standard_charges": [{"minimum": 512.71, "maximum": 512.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 512.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI PELVIS W/DYE", "code_information": [{"code": "72196", "type": "CPT"}], "standard_charges": [{"minimum": 407.42, "maximum": 407.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 407.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI PELVIS W/O & W/DYE", "code_information": [{"code": "72197", "type": "CPT"}], "standard_charges": [{"minimum": 512.07, "maximum": 512.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 512.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI PELVIS W/O DYE", "code_information": [{"code": "72195", "type": "CPT"}], "standard_charges": [{"minimum": 347.89, "maximum": 347.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 347.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI UPPER EXTREMITY W/DYE", "code_information": [{"code": "73219", "type": "CPT"}], "standard_charges": [{"minimum": 501.12, "maximum": 501.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 501.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI UPPER EXTREMITY W/O DYE", "code_information": [{"code": "73218", "type": "CPT"}], "standard_charges": [{"minimum": 414.95, "maximum": 414.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 414.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI UPPR EXTREMITY W/O&W/DYE", "code_information": [{"code": "73220", "type": "CPT"}], "standard_charges": [{"minimum": 622.94, "maximum": 622.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 622.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI W/CONT, BREAST,  BI", "code_information": [{"code": "C8906", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI W/CONT, BREAST,  UNI", "code_information": [{"code": "C8903", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI W/O FOL W/CONT, BREAST,", "code_information": [{"code": "C8908", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRI W/O FOL W/CONT, BRST, UN", "code_information": [{"code": "C8905", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRS 90 DAYS POST STK", "code_information": [{"code": "G0045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN ACQUISJ DATA", "code_information": [{"code": "609T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN ALG ALYS DATA", "code_information": [{"code": "611T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN TRANSMIS DATA", "code_information": [{"code": "610T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MRS DISCOGENIC PAIN I&R", "code_information": [{"code": "612T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MS CONTIN (MORPHINE SO4 ER) TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000510", "type": "CDM"}, {"code": "42858080101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MS CONTIN (MORPHINE SO4 ER) TAB 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000670", "type": "CDM"}, {"code": "42858080201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MSH2 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81297", "type": "CPT"}], "standard_charges": [{"minimum": 245.3, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 245.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE FULL SEQ", "code_information": [{"code": "81295", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 438.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 438.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE KNOWN VARIANTS", "code_information": [{"code": "81296", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 388.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 388.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MSH2 MRNA SEQ ALYS", "code_information": [{"code": "159U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81300", "type": "CPT"}], "standard_charges": [{"minimum": 273.7, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 273.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE FULL SEQ", "code_information": [{"code": "81298", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 738.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 738.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE KNOWN VARIANTS", "code_information": [{"code": "81299", "type": "CPT"}], "standard_charges": [{"minimum": 354.2, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 354.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MSH6 MRNA SEQ ALYS", "code_information": [{"code": "160U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MT BONE GRAFT MICROVASC", "code_information": [{"code": "20957", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTHFR GENE", "code_information": [{"code": "81291", "type": "CPT"}], "standard_charges": [{"minimum": 75.14, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 75.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM ADDL 15 MIN", "code_information": [{"code": "99607", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM EST 15 MIN", "code_information": [{"code": "99606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM NP 15 MIN", "code_information": [{"code": "99605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUCINEX COLD LIQ (guaif/pheny) 100/2.5/5", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000626", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MUCINEX D (GUAIF/PSEUDO) TAB 600/60", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000442", "type": "CDM"}, {"code": "63824005718", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MUCINEX DM ER (GUAIFEN/DM) TAB 600/30", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000276", "type": "CDM"}, {"code": "50090107700", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MUCINEX ER (GUAIFENESIN) TAB 600MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000324", "type": "CDM"}, {"code": "63824000832", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MUCOMYST (ACETYLCYSTEINE) 20% INH SOL", "drug_information": {"unit": 6.0, "type": "EA"}, "code_information": [{"code": "7000006", "type": "CDM"}, {"code": "63323069044", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MUCOMYST 10% INH SOL 100MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002117", "type": "CDM"}, {"code": "00409330703", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MUCOPOLYSACCHARIDES", "code_information": [{"code": "83864", "type": "CPT"}], "standard_charges": [{"minimum": 32.78, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUCORMYCOSIS ANTIBODY", "code_information": [{"code": "86732", "type": "CPT"}], "standard_charges": [{"minimum": 17.25, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUCUS TRAP", "code_information": [{"code": "S8210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULT FAM ADAPT BHV TX GDN", "code_information": [{"code": "97157", "type": "CPT"}], "standard_charges": [{"minimum": 15.07, "maximum": 15.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULTAQ (DRONEDARONE) TAB 400MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000729", "type": "CDM"}, {"code": "00024414260", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MULTI-POSITION STND FRAM SYS", "code_information": [{"code": "E0641", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULTI-VITAMIN INFUSION (ADULT) INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000492", "type": "CDM"}, {"code": "54643564901", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MULTI-VITAMIN LIQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000213", "type": "CDM"}, {"code": "17856063202", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MULTI-VITAMIN NOS", "code_information": [{"code": "A9153", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULTIDISCIPLINARY CARE PLAN", "code_information": [{"code": "580F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULTIFOCAL ERG W/I&R", "code_information": [{"code": "92274", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULTIPLE FAMILY GROUP PSYTX", "code_information": [{"code": "90849", "type": "CPT"}], "standard_charges": [{"minimum": 683.18, "maximum": 683.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 683.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC", "code_information": [{"code": "427", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE", "code_information": [{"code": "426", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC", "code_information": [{"code": "428", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE", "code_information": [{"code": "447", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC", "code_information": [{"code": "448", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [{"code": "59", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [{"code": "58", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC", "code_information": [{"code": "60", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SLEEP LATENCY TEST", "code_information": [{"code": "95805", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULTISTIX 10 SG", "code_information": [{"code": "80000485", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MULTISYS THER/JUVENILE 15MIN", "code_information": [{"code": "H2033", "type": "HCPCS"}], "standard_charges": [{"minimum": 550.81, "maximum": 550.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 550.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUMPS ANTI IGG", "code_information": [{"code": "86735", "type": "CPT"}, {"code": "1000367", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.01, "maximum": 69.52, "gross_charge": 77.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 69.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUMPS ANTI IGM", "code_information": [{"code": "86735", "type": "CPT"}, {"code": "1000067", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.01, "maximum": 69.52, "gross_charge": 77.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 69.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MURAMIDASE", "code_information": [{"code": "85549", "type": "CPT"}], "standard_charges": [{"minimum": 21.56, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MURINE EAR OTIC SOLUTION 6.5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001125", "type": "CDM"}, {"code": "78112073621", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 26.49, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MUSC MYOQ/FSCQ FLP H&N PEDCL", "code_information": [{"code": "15733", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSC TEST DONE W/N TEST COMP", "code_information": [{"code": "95886", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSC TST DONE W/N TST NONEXT", "code_information": [{"code": "95887", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSC TST DONE W/NERV TST LIM", "code_information": [{"code": "95885", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSC/TDN TRANSFER UPR A/E 1", "code_information": [{"code": "24301", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE BIOPSY SUPERFICIAL", "code_information": [{"code": "20200", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 2 LIMBS", "code_information": [{"code": "95861", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 3 LIMBS", "code_information": [{"code": "95863", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 4 LIMBS", "code_information": [{"code": "95864", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERV UNILAT", "code_information": [{"code": "95867", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERVE BILAT", "code_information": [{"code": "95868", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST HEMIDIAPHRAGM", "code_information": [{"code": "95866", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST LARYNX", "code_information": [{"code": "95865", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST NONPARASPINAL", "code_information": [{"code": "95870", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE FIBER", "code_information": [{"code": "95872", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE LIMB", "code_information": [{"code": "95860", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST THOR PARASPINAL", "code_information": [{"code": "95869", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFER SHOULDER/ARM", "code_information": [{"code": "23395", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFERS", "code_information": [{"code": "23397", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT ARM", "code_information": [{"code": "15736", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT LEG", "code_information": [{"code": "15738", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT TRUNK", "code_information": [{"code": "15734", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SPECIFIC KINASE ANTB", "code_information": [{"code": "86366", "type": "CPT"}], "standard_charges": [{"minimum": 21.16, "maximum": 21.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYCAMINE (MICAFUNGIN) 100MG/100ML NS", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J2248", "type": "HCPCS"}, {"code": "72001079", "type": "CDM"}, {"code": "00469321110", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 267.21, "maximum": 491.4, "gross_charge": 546.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 311.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCELEX (CLOTRIMAZOLE) LOZG 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000325", "type": "CDM"}, {"code": "00054414622", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA AMP PROBE", "code_information": [{"code": "87551", "type": "CPT"}], "standard_charges": [{"minimum": 55.48, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA DIR PROBE", "code_information": [{"code": "87550", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA QUANT", "code_information": [{"code": "87552", "type": "CPT"}], "standard_charges": [{"minimum": 49.27, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIC IDENTIFICATION", "code_information": [{"code": "87118", "type": "CPT"}], "standard_charges": [{"minimum": 16.8, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYCOLOG-II CREAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001062", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MYCOPHENOLIC ACID", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7518", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYCOPHENOLIC ACID & METABOLITE", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "1000542", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 27.7, "maximum": 96.2, "gross_charge": 106.89, "discounted_cash": 54.17, "estimated_discounted_cash": 106.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA", "code_information": [{"code": "87109", "type": "CPT"}], "standard_charges": [{"minimum": 17.7, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA IgG", "code_information": [{"code": "86738", "type": "CPT"}, {"code": "1000570", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.23, "maximum": 96.7, "gross_charge": 78.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.71, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA IgM", "code_information": [{"code": "86738", "type": "CPT"}, {"code": "1000571", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.23, "maximum": 96.7, "gross_charge": 78.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.71, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYD88 GENE P.LEU265PRO VRNT", "code_information": [{"code": "81305", "type": "CPT"}], "standard_charges": [{"minimum": 201.71, "maximum": 201.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOGPHY 2/> SPINE REGIONS", "code_information": [{"code": "72270", "type": "CPT"}], "standard_charges": [{"minimum": 214.96, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 214.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY L-S SPINE", "code_information": [{"code": "72265", "type": "CPT"}], "standard_charges": [{"minimum": 140.49, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 140.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62302", "type": "CPT"}], "standard_charges": [{"minimum": 1871.2, "maximum": 1871.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1871.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62303", "type": "CPT"}], "standard_charges": [{"minimum": 1871.2, "maximum": 1871.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1871.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62304", "type": "CPT"}], "standard_charges": [{"minimum": 1871.2, "maximum": 1871.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1871.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62305", "type": "CPT"}], "standard_charges": [{"minimum": 1871.2, "maximum": 1871.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1871.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY NECK SPINE", "code_information": [{"code": "72240", "type": "CPT"}], "standard_charges": [{"minimum": 148.4, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY THORACIC SPINE", "code_information": [{"code": "72255", "type": "CPT"}], "standard_charges": [{"minimum": 151.3, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "827", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "826", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "828", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC", "code_information": [{"code": "829", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "830", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "MYLANTA 200/200/20/5ml 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000038", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MYLANTA MAX 400/400/40/5ml 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000598", "type": "CDM"}, {"code": "00536001583", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MYOCARDIAL IMAGING MCG", "code_information": [{"code": "541T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCARDIAL IMAGING MCG I&R", "code_information": [{"code": "542T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD CONTRAST PRFUJ ECHO", "code_information": [{"code": "439T", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1 STD W/CT", "code_information": [{"code": "78429", "type": "CPT"}], "standard_charges": [{"minimum": 856.92, "maximum": 856.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 856.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1STD RST/STRS", "code_information": [{"code": "78491", "type": "CPT"}], "standard_charges": [{"minimum": 855.76, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 855.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER", "code_information": [{"code": "78432", "type": "CPT"}], "standard_charges": [{"minimum": 1551.96, "maximum": 1551.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1551.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER CT", "code_information": [{"code": "78433", "type": "CPT"}], "standard_charges": [{"minimum": 1553.71, "maximum": 1553.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1553.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET MLT RST&STRS", "code_information": [{"code": "78492", "type": "CPT"}], "standard_charges": [{"minimum": 858.87, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 858.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST&STRS CT", "code_information": [{"code": "78431", "type": "CPT"}], "standard_charges": [{"minimum": 1272.6, "maximum": 1272.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1272.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST/STRS W/CT", "code_information": [{"code": "78430", "type": "CPT"}], "standard_charges": [{"minimum": 856.53, "maximum": 856.53, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 856.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET SINGLE STUDY", "code_information": [{"code": "78459", "type": "CPT"}], "standard_charges": [{"minimum": 757.22, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 757.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD STRAIN IMG SPCKL TRCK", "code_information": [{"code": "93356", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN SERUM", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "1000185", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.86, "maximum": 68.79, "gross_charge": 76.44, "discounted_cash": 54.17, "estimated_discounted_cash": 74.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.15, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN URINE", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "1000612", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.86, "maximum": 68.79, "gross_charge": 76.44, "discounted_cash": 54.17, "estimated_discounted_cash": 74.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.15, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM COMPLEX", "code_information": [{"code": "58146", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM METHOD", "code_information": [{"code": "58140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY VAG METHOD", "code_information": [{"code": "58145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOWN HARV PREP PROC SQ CM", "code_information": [{"code": "Q4226", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYRBETRIQ ER TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000965", "type": "CDM"}, {"code": "70710115903", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 40.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MYRINGOTOMY LASER-ASSIST", "code_information": [{"code": "S2225", "type": "HCPCS"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYSOLINE (PRIMIDONE) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000207", "type": "CDM"}, {"code": "53746054501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "MYSOLINE (PRIMIDONE) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000255", "type": "CDM"}, {"code": "68084020201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation of target, intracranial, including stereotactic navigation and frame placement, when performed", "code_information": [{"code": "61715", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Magnetic resonance image guided low intensity focused ultrasound (MRgFUS), stereotactic blood-brain barrier disruption using microbubble resonators to increase the concentration of blood-based biomarkers of target, intracranial, including stereotactic nav", "code_information": [{"code": "947T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of a new patient with dementia, low complexity, for use in CMMI model", "code_information": [{"code": "G0522", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of a new patient with dementia, moderate to high complexity, for use in CMMI model", "code_information": [{"code": "G0523", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of established patient with dementia, low complexity, for use in CMMI model", "code_information": [{"code": "G0527", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of established patient with dementia, moderate to high complexity, for use in CMMI model", "code_information": [{"code": "G0528", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of established patient-caregiver dyad with dementia, high complexity, for use in CMMI model", "code_information": [{"code": "G0526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of established patient-caregiver dyad with dementia, low complexity, for use in CMMI model", "code_information": [{"code": "G0524", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of established patient-caregiver dyad with dementia, moderate complexity, for use in CMMI model", "code_information": [{"code": "G0525", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of new patient-caregiver dyad with dementia, high complexity, for use in CMMI model", "code_information": [{"code": "G0521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of new patient-caregiver dyad with dementia, low complexity, for use in CMMI model", "code_information": [{"code": "G0519", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Management of new patient-caregiver dyad with dementia, moderate complexity, for use in CMMI model", "code_information": [{"code": "G0520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mantle DL matrix, per square centimeter", "code_information": [{"code": "Q4349", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MatriDerm, per square centimeter", "code_information": [{"code": "A2027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Matrix HD Allograft Dermis, per square centimeter", "code_information": [{"code": "Q4345", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical genetics and genetic counseling services, each 30 minutes of total time provided by the genetic counselor on the date of the encounter", "code_information": [{"code": "96041", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of t", "code_information": [{"code": "G0533", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Melatonin levels test, sleep study, 7 or 9 sample melatonin profile (cortisol optional), enzyme-linked immunosorbent assay (ELISA), saliva, screening/preliminary", "code_information": [{"code": "462U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Membrane Wrap Lite, per square centimeter", "code_information": [{"code": "Q4373", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Meningococcal pentavalent vaccine, Men B-4C recombinant proteins and outer membrane vesicle and conjugated Men A, C, W, Y-diphtheria toxoid carrier, for intramuscular use", "code_information": [{"code": "90624", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Methotrexate (Jylamvo), oral, 2.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Methotrexate (Xatmep), oral, 2.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8612", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MicroMatrix Flex, per mg", "code_information": [{"code": "A2028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Miglustat oral 65 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Miro3D Fibers, per milligram", "code_information": [{"code": "A2030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MiroDry Wound Matrix, per square centimeter", "code_information": [{"code": "A2031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MiroTract Wound Matrix Sheet, per cubic centimeter", "code_information": [{"code": "A2029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Missing and murdered indigenous persons (MMIP) mental health and clinical care", "code_information": [{"code": "H0052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Most recent glycemic status assessment (HBA1c or GMI) level < 7.0%", "code_information": [{"code": "M1371", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Most recent glycemic status assessment (HBA1c or GMI) level >= 7.0% and < 8.0%", "code_information": [{"code": "M1372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Most recent glycemic status assessment (HBA1c or GMI) level >= 8.0% and <= 9.0%", "code_information": [{"code": "M1373", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mycobacterium tuberculosis, culture filtrate protein-10-kDa (CFP-10), serum or plasma, liquid chromatography mass spectrometry (LC-MS)", "code_information": [{"code": "574U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mycophenolate mofetil (Myhibbin), oral suspension, 100 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7514", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Myriad Matrix, per square centimeter", "code_information": [{"code": "A2032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Myriad Morcells, 4 milligrams", "code_information": [{"code": "A2033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ CELIAC PELUS", "code_information": [{"code": "64530", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ COMMON DIGIT", "code_information": [{"code": "64632", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ HYPOGAS PLXS", "code_information": [{"code": "64517", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N BLOCK LUMBAR/THORACIC", "code_information": [{"code": "64520", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N BLOCK SPENOPALATINE GANGL", "code_information": [{"code": "64505", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N BLOCK STELLATE GANGLION", "code_information": [{"code": "64510", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-ET; COMMERC CARRIER PASS", "code_information": [{"code": "T2004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-ET; ENCOUNTER/TRIP", "code_information": [{"code": "T2003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-ET; PATIENT ATTEND/ESCORT", "code_information": [{"code": "T2001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-ET; PER DIEM", "code_information": [{"code": "T2002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-ET; STRETCHER VAN", "code_information": [{"code": "T2005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-ET; STRETCHER VAN, MILEAGE", "code_information": [{"code": "T2049", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-INVAS ARTL PLAQ ALYS", "code_information": [{"code": "710T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-INVAS EST C FFR SW ALY CTA", "code_information": [{"code": "75580", "type": "CPT"}], "standard_charges": [{"minimum": 1044.96, "maximum": 1044.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1044.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-NVS ARTL PLAQ ALYS DAT PRP", "code_information": [{"code": "711T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-NVS ARTL PLAQ ALYS QUAN", "code_information": [{"code": "712T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N-NVS ARTL PLAQ ALYS RVW I&R", "code_information": [{"code": "713T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N. GONORRHOEAE ASSAY W/OPTIC", "code_information": [{"code": "87850", "type": "CPT"}], "standard_charges": [{"minimum": 23.08, "maximum": 28.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA DIR PROB", "code_information": [{"code": "87590", "type": "CPT"}], "standard_charges": [{"minimum": 30.91, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA QUANT", "code_information": [{"code": "87592", "type": "CPT"}], "standard_charges": [{"minimum": 49.27, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NA FERRIC GLUCONATE COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2916", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NABILONE ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NALTREXONE, DEPOT FORM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2315", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NAMENDA (MEMANTINE) ER 14MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001789", "type": "CDM"}, {"code": "70436005504", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.42, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NAMENDA (MEMANTINE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000124", "type": "CDM"}, {"code": "00591387044", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 9.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NAMENDA TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000406", "type": "CDM"}, {"code": "00904650606", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NAMENDA XR CAP 28MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001826", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 41.42, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NANDROLONE DECANOATE 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NAPROSYN (NAPROXEN) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000329", "type": "CDM"}, {"code": "70010013701", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NAPROXEN 220MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000463", "type": "CDM"}, {"code": "00904572514", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NARCAN (NALOXONE) 1MG/ML", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J2312", "type": "HCPCS"}, {"code": "7000328", "type": "CDM"}, {"code": "76329336901", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.89, "maximum": 14.04, "gross_charge": 15.6, "discounted_cash": 54.17, "estimated_discounted_cash": 15.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NARCOSYNTHESIS", "code_information": [{"code": "90865", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL CANNULA DIVIDER CO2/O2", "code_information": [{"code": "3001355", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASAL CANNULA LATEX FREE", "code_information": [{"code": "3001140", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOP PO DEBRID", "code_information": [{"code": "S2342", "type": "HCPCS"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOPY DX", "code_information": [{"code": "31231", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL FUNCTION STUDIES", "code_information": [{"code": "92512", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL PROSTHESIS", "code_information": [{"code": "D5913", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL SEPTAL PROSTHESIS", "code_information": [{"code": "D5922", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL SINUS THERAPY", "code_information": [{"code": "30210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL SMEAR FOR EOSINOPHILS", "code_information": [{"code": "89190", "type": "CPT"}], "standard_charges": [{"minimum": 6.66, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL VACCINE INHALATION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3530", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL/OROGASTRIC W/TUBE PLMT", "code_information": [{"code": "43752", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31287", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31288", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31290", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31291", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASONEX 50MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000744", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 3.0", "code_information": [{"code": "3000243", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 3.5", "code_information": [{"code": "3000244", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 4.0", "code_information": [{"code": "3001466", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 4.5", "code_information": [{"code": "3000245", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 5.0", "code_information": [{"code": "3000246", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 5.5", "code_information": [{"code": "3000247", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 6.0", "code_information": [{"code": "3000248", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 6.5", "code_information": [{"code": "3000249", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 7.0", "code_information": [{"code": "3000250", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 7.5", "code_information": [{"code": "3000251", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 8.0", "code_information": [{"code": "3000252", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGEAL 8.5", "code_information": [{"code": "3000253", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NASOPHARYNGOSCOPY", "code_information": [{"code": "92511", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASOPHARYNYGEAL 2.5", "code_information": [{"code": "3000035", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 14.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NATALIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2323", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NAV SRV PEER SUP 60 MIN PR M", "code_information": [{"code": "G0140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NAV SRV PEER SUP ADD 30 PR M", "code_information": [{"code": "G0146", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NAVIGATIONAL BRONCHOSCOPY", "code_information": [{"code": "31627", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NB RESUSCITATION", "code_information": [{"code": "99465", "type": "CPT"}], "standard_charges": [{"minimum": 2899.78, "maximum": 2899.78, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2899.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC O/T PAD 1", "code_information": [{"code": "640T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC O/T PAD EA", "code_information": [{"code": "859T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC SCR PAD", "code_information": [{"code": "860T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG 1ST", "code_information": [{"code": "598T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG EA", "code_information": [{"code": "599T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 1 OR 2 MUSC", "code_information": [{"code": "20560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 3+ MUSC", "code_information": [{"code": "20561", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NDL OCULOELECTROMYOGRAPHY 1+", "code_information": [{"code": "92265", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NDOVAG CRYG RF REMDL TISS", "code_information": [{"code": "672T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NDSC DCMPRN 1 NTRSPC LUMBAR", "code_information": [{"code": "62380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEAR IFR 2IMG MIBMN GLND I&R", "code_information": [{"code": "507T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEBULIZER ADAPTER", "code_information": [{"code": "3001298", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63075", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63076", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY CHEST LINING", "code_information": [{"code": "32400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LIVER ADD-ON", "code_information": [{"code": "47001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LYMPH NODES", "code_information": [{"code": "38505", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY OF LIVER", "code_information": [{"code": "47000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY PANCREAS", "code_information": [{"code": "48102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY SPINAL CORD", "code_information": [{"code": "62269", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEEDLE INTRAOSSEOUS 15MM", "code_information": [{"code": "3001335", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEEDLE INTRAOSSEOUS 25MM", "code_information": [{"code": "3001336", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEEDLE LOCALIZATION BY XRAY", "code_information": [{"code": "77002", "type": "CPT"}], "standard_charges": [{"minimum": 147.69, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 147.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEEDLE PH 20X1 1/2", "code_information": [{"code": "80001185", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 9.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEG MICROALBUMINURIA REV", "code_information": [{"code": "3061F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEG PRESS VENTILATION CNP", "code_information": [{"code": "94662", "type": "CPT"}], "standard_charges": [{"minimum": 2054.3, "maximum": 2054.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2054.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THER DME<=50SQCM", "code_information": [{"code": "97605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THER DME>50 SQCM", "code_information": [{"code": "97606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THER NDME>50SQCM", "code_information": [{"code": "97608", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THR NDME<=50SQCM", "code_information": [{"code": "97607", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEG SCRN DEP SYMP BY DEPTOOL", "code_information": [{"code": "3351F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEISSERIA GONORRHOEAE NAA", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "1000859", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 40.35, "maximum": 186.97, "gross_charge": 207.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 166.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 186.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 118.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEISSERIA MENINGITIDIS", "code_information": [{"code": "86741", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NELARABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9261", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEO-SYNEPHRINE NASAL SPRAY 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001091", "type": "CDM"}, {"code": "69536017515", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEO/POLY-B/DEX OPHTH. SUSP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001115", "type": "CDM"}, {"code": "24208083060", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 36.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEO/POLY/HYDRO OPTH DROPS 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000384", "type": "CDM"}, {"code": "24208063562", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEOMATRIX PER SQ CM", "code_information": [{"code": "A2021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOMY/POLY B/BACIT ZINC OPTH OINT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000669", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 35.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEOMYC/BAC/POLY/HC 1% OPTH OINT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000269", "type": "CDM"}, {"code": "24208078555", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 89.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEONATAL EMERGENCY TRANSPORT", "code_information": [{"code": "A0225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE INITIAL", "code_information": [{"code": "99468", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE SUBSQ", "code_information": [{"code": "99469", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [{"code": "794", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [{"code": "789", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEOPATCH OR THERION, 1 SQ CM", "code_information": [{"code": "Q4176", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOSTIGMINE METHYLSLFTE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOSTIM DL PER SQ CM", "code_information": [{"code": "Q4267", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOSTIM PER SQ CM", "code_information": [{"code": "Q4266", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOSTIM TL PER SQ CM", "code_information": [{"code": "Q4265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOX 100 OR CLARIX 100", "code_information": [{"code": "Q4156", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOX NEOX RT OR CLARIX CORD", "code_information": [{"code": "Q4148", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOXFLO OR CLARIXFLO 1 MG", "code_information": [{"code": "Q4155", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPH CKD ALG RSK DBTC KDN DS", "code_information": [{"code": "385U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPH CKD MULT ECLIA TUM NEC", "code_information": [{"code": "105U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPH CKD NUC MRS MEAS GFR", "code_information": [{"code": "259U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPH CKD RSK HI STG KDN DS", "code_information": [{"code": "384U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPH RNA PRETRNSPL PERPH BLD", "code_information": [{"code": "319U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPH RNA PSTTRNSPL PERPH BLD", "code_information": [{"code": "320U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPHROLOGY SS", "code_information": [{"code": "G4014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPHROPATHY DOC TX", "code_information": [{"code": "3066F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPHROTOMY W/EXPLORATION", "code_information": [{"code": "50045", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPRO W/ CARB STEADY VANILLA", "code_information": [{"code": "80001229", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NERVE GRAFT ADD-ON", "code_information": [{"code": "64901", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT ADD-ON", "code_information": [{"code": "64902", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK <4 CM", "code_information": [{"code": "64885", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK >4 CM", "code_information": [{"code": "64886", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY FASCIAL GRAFT", "code_information": [{"code": "15840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MICROSURG GRAFT", "code_information": [{"code": "15842", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MUSCLE GRAFT", "code_information": [{"code": "15841", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64905", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64907", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE REPAIR W/ALLOGRAFT", "code_information": [{"code": "64910", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE SURGERY", "code_information": [{"code": "64859", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVE TEASING PREPARATIONS", "code_information": [{"code": "88362", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 239.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 239.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [{"code": "54", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [{"code": "55", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NESIRITIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2325", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL A-SYNCLN PRTN", "code_information": [{"code": "393U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL _-SYNCLN PRTN", "code_information": [{"code": "394U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURAGEN NERVE GUIDE, PER CM", "code_information": [{"code": "C9352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURAWRAP NERVE PROTECTOR,CM", "code_information": [{"code": "C9353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURAXL LBR ANES VAG DLVR", "code_information": [{"code": "1967", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY FOOT", "code_information": [{"code": "28055", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY HAMSTRING", "code_information": [{"code": "27325", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY POPLITEAL", "code_information": [{"code": "27326", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURFLMNT LT CHN DIG IA QUAN", "code_information": [{"code": "361U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO ALYS B-AMYL 1-42&1-40", "code_information": [{"code": "358U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER CELL AGGREGJ", "code_information": [{"code": "206U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER MRNA 24 GEN", "code_information": [{"code": "289U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER QUAN IMAGING", "code_information": [{"code": "207U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 14 ACYL CARN", "code_information": [{"code": "322U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 16 C METBLT", "code_information": [{"code": "263U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO ASD RNA NEXT GEN SEQ", "code_information": [{"code": "170U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO AUTISM 32 AMINES ALG", "code_information": [{"code": "63U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "410U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "412U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO CSF PRION PRTN QUAL", "code_information": [{"code": "35U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 12 COM", "code_information": [{"code": "216U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 51 GENE", "code_information": [{"code": "217U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURO MUSC DYS DMD SEQ ALYS", "code_information": [{"code": "218U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROELTRD STIM POST TIBIAL", "code_information": [{"code": "64566", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROENDOSCOPY ADD-ON", "code_information": [{"code": "62160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROLOGICAL EYE DISORDERS", "code_information": [{"code": "123", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEUROLOGY SS", "code_information": [{"code": "G4015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROMATRIX NERVE CUFF, CM", "code_information": [{"code": "C9355", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROMEND NERVE WRAP", "code_information": [{"code": "C9361", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR JUNCTION TEST", "code_information": [{"code": "95937", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR REEDUCATION", "code_information": [{"code": "97112", "type": "CPT"}], "standard_charges": [{"minimum": 32.34, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 117.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURONTIN (GABAPENTIN) CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000207", "type": "CDM"}, {"code": "63739090210", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEURONTIN (GABAPENTIN) CAP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000252", "type": "CDM"}, {"code": "00904666661", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEURONTIN (GABAPENTIN) CAP 400MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000387", "type": "CDM"}, {"code": "60687060201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEURONTIN (GABAPENTIN) TAB 600MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001715", "type": "CDM"}, {"code": "51224002150", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEURONTIN LEVEL", "code_information": [{"code": "80299", "type": "CPT"}, {"code": "1000226", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 21.44, "maximum": 72.92, "gross_charge": 81.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.82, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROPSYCHI SYMPT 1+PRESENT", "code_information": [{"code": "1182F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROPSYCHIA INTERVEN ORDER", "code_information": [{"code": "4525F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROPSYCHIA INTERVEN RCVD", "code_information": [{"code": "4526F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROPSYCHIA SYMPTS ASSESSED", "code_information": [{"code": "1181F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROPSYCHIATRIC SYMP ABSENT", "code_information": [{"code": "1183F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEURORRAPHY W/VEIN AUTOGRAFT", "code_information": [{"code": "64911", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [{"code": "882", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEUROSURGICAL SS", "code_information": [{"code": "G4016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROVASCULAR PEDICLE FLAP", "code_information": [{"code": "15750", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUTRALIZATION TEST VIRAL", "code_information": [{"code": "86382", "type": "CPT"}], "standard_charges": [{"minimum": 19.45, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 SCR", "code_information": [{"code": "86408", "type": "CPT"}], "standard_charges": [{"minimum": 42.13, "maximum": 42.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 TITER", "code_information": [{"code": "86409", "type": "CPT"}], "standard_charges": [{"minimum": 105.33, "maximum": 105.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 105.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUTRON BEAM TX COMPLEX", "code_information": [{"code": "77423", "type": "CPT"}], "standard_charges": [{"minimum": 139.62, "maximum": 1554.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 139.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1554.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEW EPISODE FOR CONDITION", "code_information": [{"code": "1127F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEW HDACHE PED PT DIS", "code_information": [{"code": "G2194", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEW IMAGE 2 PIECE POUCHING SYSTEM 2-3/4", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "80001190", "type": "CDM"}, {"code": "00409613822", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEW IMAGE DRAINABLE POUCH 12", "code_information": [{"code": "3001342", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEW IMAGE DRAINABLE POUCH W/FILTER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3001293", "type": "CDM"}, {"code": "00409613822", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEW IMAGE SKIN BARRIER FLOATING FLANGE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3001294", "type": "CDM"}, {"code": "00409613822", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.47, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEW LENSES IN PTS OLD FRAME", "code_information": [{"code": "S0595", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEWBORN METABOLIC SCREENING", "code_information": [{"code": "S3620", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEXIUM (ESOMEPRAZOLE) 40MG IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001081", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEXIUM (ESOMEPRAZOLE) 40MG/100ML NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001080", "type": "CDM"}, {"code": "55150018505", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEXIUM (ESOMEPRAZOLE) SUSP 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000897", "type": "CDM"}, {"code": "00186404001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 26.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEXIUM (NF-NEXIUM) CAP DR 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001036", "type": "CDM"}, {"code": "43598050930", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NEXIUM DR (ESOMEPRAZOLE) CAP 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000268", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN+", "code_information": [{"code": "99316", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN/LESS", "code_information": [{"code": "99315", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NF-ABILIFY TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001950", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ACTOPLUS MET ORAL TABLET 15/850MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000789", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ALAHIST DM SOLN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000677", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ALOSETRON HCL 1MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003613", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 52.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-AMIODARONE HCL TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001012", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ARAVA ORAL TABLET 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001840", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-AVAPRO 300MG ORAL TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000766", "type": "CDM"}, {"code": "31722073190", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-AVINZA 24 HR CAP 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001215", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Acarbose Oral Tablet 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003236", "type": "CDM"}, {"code": "00054014025", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Alfuzosin Hydrochloride Tab ER 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003282", "type": "CDM"}, {"code": "57237011490", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Alogliptin Benzoate Oral Tablet 12.5M", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003012", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 37.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Anoro Ellipta Inhalation Powder", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003067", "type": "CDM"}, {"code": "00173086910", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1572.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Anusol-HC Rectal Cream 2.5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003827", "type": "CDM"}, {"code": "69315031228", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 75.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Azelastine HCl Nasal Spray 137MCG/1IN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003820", "type": "CDM"}, {"code": "59651021430", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 29.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Azo Urinary Tract Health Oral Tablet", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002861", "type": "CDM"}, {"code": "87651042067", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-BIAXIN FILMTAB ORAL TABLET 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001543", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-BREO ELLIPTA INH PWD 200MCG-25MCG/1AC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002097", "type": "CDM"}, {"code": "00173088210", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 1114.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-BROVANA INH SOLN 15MCG/2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001056", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-BROVANA INHALATION SOLUTION 15MCG/2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000842", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-BUPROPION SR ORAL TAB ER 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001314", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-BUSPAR TABLET 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000973", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Betamethasone Dipropionate 0.05% Crea", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003829", "type": "CDM"}, {"code": "51672131003", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 72.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Bethanechol Chloride Oral Tablet 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003234", "type": "CDM"}, {"code": "00832051101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Biotin Tablet 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003314", "type": "CDM"}, {"code": "54629398501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-CALCIUM CARBONATE 1250MG ORAL TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001217", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-CALTRATE PLUS TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001335", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-CELLCEPT CAP 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000945", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-CHLORPHENIRAMINE MALEATE ORAL TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001707", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-CIPRODEX OTIC SUSP 0.3%-0.1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001551", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-COUMADIN TAB 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001172", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "340", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-CYCLOSPORINE CAP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001230", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Calan SR Oral Tablet Extended Release", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003070", "type": "CDM"}, {"code": "68462029201", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Cefdinir Oral Pwd for Susp 250MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002876", "type": "CDM"}, {"code": "00093413773", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Cerefolin Tablet", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002966", "type": "CDM"}, {"code": "76439036090", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Chloraseptic Mucous Membrane Lonzenge", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002461", "type": "CDM"}, {"code": "78112001106", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Chlorthalidone Tablet 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003527", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.77, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Clobetasol Propionate Solution 0.05%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004349", "type": "CDM"}, {"code": "51672129303", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 108.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Combigan Ophth Soln 0.2%-0.5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003780", "type": "CDM"}, {"code": "00023921105", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 549.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Coumadin Tablet 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002786", "type": "CDM"}, {"code": "00093171501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Cranberry Fruit Capsule 425MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002580", "type": "CDM"}, {"code": "87651042067", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Creon Oral Delayed Release Capsule", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003291", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Culturelle Oral Capsule 10 Billion OR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002019", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Cyproheptadine HCl Oral Syrup 2MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002598", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DALIRESP 500MCG ORAL TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000823", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DELSYM ORAL SUSP ER 30MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001356", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DELSYM ORAL SUSPENSION 30MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001819", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DEXILANT 60MG ORAL CAPSULE, DELAYED R", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001125", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DICLOFENAC SODIUM DR ORAL TABLET 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000878", "type": "CDM"}, {"code": "61442010310", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DRAMAMINE CHEWABLE TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001995", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DULERA INH AER PWD 5MCG-100MCG/ACT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000600", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 909.54, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DULERA INH AER PWD 5MCG-200MCG/ACT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001052", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-DULERA INH AER PWD 5MCG-200MCG/ACT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001651", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Dakin's Solution Half Strength Soluti", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004684", "type": "CDM"}, {"code": "00436093616", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Desipramine HCl Tablet 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003502", "type": "CDM"}, {"code": "69238105501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Desvenlafaxine Oral Tablet ER 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003140", "type": "CDM"}, {"code": "59762122203", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Diclofenac Potassium Oral Tablet 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003540", "type": "CDM"}, {"code": "72888007301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Dulera Inh Aer Pwd 5MCG-200MCG/Act", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003393", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 911.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ELIQUIS ORAL TABLET 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001596", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ELIQUIS ORAL TABLET 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001603", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-EPOGEN 4000U/ML INJECTION SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001532", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ESGIC CAP 325MG-50MG-40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000705", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ESTRACE (ESTRADIOL) TAB 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001591", "type": "CDM"}, {"code": "00555089902", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-EX-LAX ORAL TABLET 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001871", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-EZETIMIBE ORAL TABLET 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000876", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-EZFE 200 Oral Capsule 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003525", "type": "CDM"}, {"code": "12830082401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Effient Oral Tablet 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002397", "type": "CDM"}, {"code": "60505464303", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Elidel Topical Cream 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003900", "type": "CDM"}, {"code": "00591294460", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 957.03, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Enoxaparin Sodium Inj Soln 150MG/1ML", "drug_information": {"unit": 15.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "7002849", "type": "CDM"}, {"code": "00548560700", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 20.02, "maximum": 31.61, "gross_charge": 35.13, "discounted_cash": 54.17, "estimated_discounted_cash": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 31.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF-Erythromycin Ophthalmic Ointment 5MG/", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003116", "type": "CDM"}, {"code": "00574402450", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Esgic Oral Capsule 325MG-50MG-40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003891", "type": "CDM"}, {"code": "00527169505", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-FLECTOR PATCH ER 1.3%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001547", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-FLORINEF ACETATE TAB 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001745", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Fludrocortisone Acetate Tablet 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001892", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-FlutiCare Nasal Spray 0.05MG/1ACTUATI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002624", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Folinic-Plus Oral Tablet 4MG-2MG-50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003142", "type": "CDM"}, {"code": "66594069290", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-GALANTAMINE HYDROBROMIDE CAP ER 16MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001985", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-GEODON CAP 60MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001302", "type": "CDM"}, {"code": "68180033307", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-GLYBURIDE 5MG ORAL TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001508", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Gammagard Liquid IV Solution 20GM/200", "drug_information": {"unit": 40.0, "type": "EA"}, "code_information": [{"code": "J1568", "type": "HCPCS"}, {"code": "72001035", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 2797.88, "maximum": 7308.2, "gross_charge": 4908.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3681.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3926.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 4417.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2797.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF-Gammaked Injection Solution 10%", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J1561", "type": "HCPCS"}, {"code": "7002753", "type": "CDM"}, {"code": "76125090001", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 71.66, "maximum": 12412.57, "gross_charge": 125.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 94.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 100.57, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 113.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 71.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF-Garlic Tablet 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003461", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-HYDROcodone and APAP 7.5MG-325MG/15ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002885", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-HYDROmorphone HCl Tablet 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1170", "type": "HCPCS"}, {"code": "7002936", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Homatropine/HYDROcodone 1.5MG-5MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002978", "type": "CDM"}, {"code": "00472103016", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Hydroxyurea Capsule 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003197", "type": "CDM"}, {"code": "49884072401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-IMIPRAMINE HCL ORAL TABLET 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001797", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-IMIPRAMINE HCL TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001780", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-INSPRA ORAL TABLET 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001343", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-INVOKANA (CANAGLIFLOZIN) TAB 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001807", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Infant & Toddler Multivitamin Drops I", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003399", "type": "CDM"}, {"code": "00087040501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Invokana Oral Tablet 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002051", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Invokana Oral Tablet 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003431", "type": "CDM"}, {"code": "50458014130", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 50.97, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-JANTOVEN ORAL TABLET 7.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001315", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-JUVEN ORAL POWDER FOR SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001010", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Juven Oral Powder For Solution", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002809", "type": "CDM"}, {"code": "59781066679", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-KLOR-CON 8 ORAL TAB ER 8MEQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001602", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LACTOBACILLUS COMBINATION CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001522", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LATANOPROST 0.005% OPHTHALMIC SOLUTIO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001103", "type": "CDM"}, {"code": "61314054701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LEFLUNOMIDE ORAL TABLET 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000577", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LIDOCAINE VISCOUS MM SOLUTION 2%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000658", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LISINOPRIL ORAL TABLET 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001675", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LITHIUM CARBONATE SR 450MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002582", "type": "CDM"}, {"code": "00378145001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LOTREL CAP 10MG-20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001808", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LOTRISONE LOTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003957", "type": "CDM"}, {"code": "51672130803", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LOVAZA 1GM ORAL CAPSULE, LIQUID FILLE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001317", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LYRICA 200MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002588", "type": "CDM"}, {"code": "59762135401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-LYRICA CAP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003018", "type": "CDM"}, {"code": "69238131709", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Latuda Oral Tablet 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002419", "type": "CDM"}, {"code": "63402030430", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 114.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Levocetirizine Dihydrochloride Tab 5M", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002652", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Lotemax Ophthalmic Gel 0.5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003273", "type": "CDM"}, {"code": "24208050307", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 470.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MACRODANTIN 100MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002768", "type": "CDM"}, {"code": "47781030801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MAGNESIUM EC DR ORAL TABLET 64MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001725", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MARINOL CAPSULE 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001864", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MEDROL 4MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003700", "type": "CDM"}, {"code": "00904691461", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MEDROL DOSEPAK ORAL TABLET 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002173", "type": "CDM"}, {"code": "59746000103", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MEDROL ORAL TABLET 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "54", "type": "CDM"}, {"code": "59746000106", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MELATONIN 20MG ORAL CAPSULE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001499", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MERREM (MEROPENEM) 500MG/ 100ML NS", "drug_information": {"unit": 5.0, "type": "EA"}, "code_information": [{"code": "72001114", "type": "CDM"}, {"code": "55150020720", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 8.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-METHADONE HCL TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001635", "type": "CDM"}, {"code": "00054457125", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MOVANTIK ORAL TABLET 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001747", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MYCOPHENOLATE MOFETIL 250MG ORAL CAPS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001115", "type": "CDM"}, {"code": "23155083005", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-MYRBETRIQ ORAL TABLET 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001984", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Marinol Oral Liq Cap 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002772", "type": "CDM"}, {"code": "67877056960", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Maxalt Tablet 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003892", "type": "CDM"}, {"code": "67877026218", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 11.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Meclizine Hydrochloride Tablet 12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002877", "type": "CDM"}, {"code": "50268052215", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Medrol Oral Tablet 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003767", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Miconazole Nitrate Cream 2%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003061", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 98.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Myrbetriq Oral Tablet 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002890", "type": "CDM"}, {"code": "00469260230", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 52.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-NEPHRO-VITE TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001159", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-NEUPOGEN INJ SOLN 480MCG/0.8ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1441", "type": "HCPCS"}, {"code": "7001395", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 940.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-NIACIN CAPSULE EXTENDED RELEASE 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001975", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-NIMODIPINE LIQ CAP 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000944", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-NINJACOF SOLUTION 12.5MG-12.5MG/1ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001095", "type": "CDM"}, {"code": "23359003216", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-NIX ULTRA SHAMPOO KIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001104", "type": "CDM"}, {"code": "63736012002", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 80.37, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-NOVOLIN N INJECTION 100U/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001342", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Nabumetone 750MG Tablet", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003539", "type": "CDM"}, {"code": "50228046601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Nephro-Vite Rx Tablet", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002784", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Neurontin Solution 250MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002728", "type": "CDM"}, {"code": "00071201223", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-OLANZapine Disintegrating Tab 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002586", "type": "CDM"}, {"code": "33342008507", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-OLANZapine Oral Tablet 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002552", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-OMNICEF CAP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000608", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Onglyza Oral Tablet 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002785", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 39.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PALGIC TAB 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001256", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PARoxetine HCl Tablet 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002895", "type": "CDM"}, {"code": "43547034903", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PEN-VK ORAL TABLET 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002029", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PENICILLIN G POTASSIUM 20 MILLION U", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "7001545", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "estimated_discounted_cash": 149.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF-PEPTO-BISMOL CHEWABLE TAB 262MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001577", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-POTASSIUM CHLORIDE LIQUID 20MEQ/15ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001523", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PRAZOSIN HCL (MINIPRESS) CAP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001418", "type": "CDM"}, {"code": "59762531001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PREMARIN VAG CRM 0.625MG/1GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001565", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PRISTIQ TAB ER 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "11", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PRO-STAT 64 ORAL LIQUID", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000541", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PROBIOTIC & ACIDOPHILUS ORAL CAPSULE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001305", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PROBIOTIC DIGESTIVE CARE CAP 20 BILLI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001367", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PROLENSA OPHTHALMIC SOLUTION 0.07%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001094", "type": "CDM"}, {"code": "24208060203", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 833.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PRORENAL VITAL ORAL TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001248", "type": "CDM"}, {"code": "51759000201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PROTONIX INJECTION 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001385", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PULMICORT INH/NEB SUSP 0.5MG/2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000641", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Pen-VK Oral Tablet 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002556", "type": "CDM"}, {"code": "65862017605", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Penicillin VK Oral Tablet 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002804", "type": "CDM"}, {"code": "65862017605", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Perforomist Inhalation Soln 20MCG/2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003562", "type": "CDM"}, {"code": "49502060530", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Piroxicam Capsule 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003141", "type": "CDM"}, {"code": "59762014501", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Potassium Chloride Powder 20meq", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003694", "type": "CDM"}, {"code": "69238161703", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Pradaxa Oral Capsule 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003600", "type": "CDM"}, {"code": "00597035509", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Prenatal Vitamin Oral Tablet", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002719", "type": "CDM"}, {"code": "44946104509", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Preparation H Rectal Cream", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002629", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-PreserVision Areds Liquid Filled Caps", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003283", "type": "CDM"}, {"code": "24208063210", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Pro-Stat Sugar Free Liquid", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002810", "type": "CDM"}, {"code": "26974041007", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Progesterone Oral Capsule 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003402", "type": "CDM"}, {"code": "59651015201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-REQUIP (ROPINIROLE HCL) 3MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003491", "type": "CDM"}, {"code": "43547027210", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-REQUIP ORAL TABLET 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001576", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ROBINUL FORTE TAB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002004", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Refresh Tears Ophth Solution 0.5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004174", "type": "CDM"}, {"code": "00023920515", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 27.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Remedy Calazime Topical Paste", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003867", "type": "CDM"}, {"code": "53329016544", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 5.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Requip XL Oral Tab ER 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003335", "type": "CDM"}, {"code": "00228365803", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Ritalin Tablet 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002448", "type": "CDM"}, {"code": "00406114201", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-SAVELLA ORAL TABLET 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000592", "type": "CDM"}, {"code": "00456155060", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 19.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-SLOW FE TABLET 160MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001422", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-STALEVO 150MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003334", "type": "CDM"}, {"code": "00781565401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-SULFASALAZINE 500MG ORAL TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001711", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-SULFASALAZINE TABLET 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001677", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-SYSTANE LUBRICANT EYE DROPS 0.4%-0.3%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "79", "type": "CDM"}, {"code": "00065045407", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Savella Oral Tablet 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003313", "type": "CDM"}, {"code": "00456151060", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 19.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Simethicone Oral Tablet, Chewable 125", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002454", "type": "CDM"}, {"code": "00067011748", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Sinemet 25-250 Oral Tablet 25MG-250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003432", "type": "CDM"}, {"code": "00228254010", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Strattera Oral Capsule 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002813", "type": "CDM"}, {"code": "66993004330", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Systane Balance Ophth Soln 0.6%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003797", "type": "CDM"}, {"code": "00065143302", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 44.07, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-TACROLIMUS IV SOLN 5MG/1ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7525", "type": "HCPCS"}, {"code": "7001382", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 148.2, "maximum": 509.24, "gross_charge": 260.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 148.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF-TEFLARO IV POWDER FOR SOLUTION 600MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001788", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-TIMOLOL MALEATE OPHTH SOLN 0.5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002021", "type": "CDM"}, {"code": "64980051405", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 23.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-TOFRANIL ORAL TABLET 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001825", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-TRADJENTA ORAL TABLET 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001061", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-TRANDOLAPRIL 4MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003788", "type": "CDM"}, {"code": "68180056801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-TRICOR ORAL TABLET 48MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001643", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-TUSSIONEX PENNKINETIC SUSPENSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001448", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Tacrolimus Oral Capsule 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002641", "type": "CDM"}, {"code": "70377001511", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Tofranil Oral Tablet 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002721", "type": "CDM"}, {"code": "49884005401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Tolterodine Tartrate Oral Tablet 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002743", "type": "CDM"}, {"code": "59762017006", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Tradjenta Oral Tablet 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001930", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Trileptal Oral Tablet 600MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003808", "type": "CDM"}, {"code": "51991029401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Trileptal Tablet 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003639", "type": "CDM"}, {"code": "51991029301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Trospium Chloride Oral Tablet 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003826", "type": "CDM"}, {"code": "23155053006", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Ursodiol Oral Capsule 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003521", "type": "CDM"}, {"code": "69238154001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-VALTREX 500MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000522", "type": "CDM"}, {"code": "57237004290", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-VANTIN TABLET 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001839", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Valproic Acid Oral Syrup 250MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002802", "type": "CDM"}, {"code": "50383079216", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Vancocin Oral Capsule 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003759", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Ventolin HFA Inhaler 0.09MG/Inh", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002421", "type": "CDM"}, {"code": "00173068220", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Voltaren Gel Topical 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002342", "type": "CDM"}, {"code": "69097052444", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 53.97, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-WELCHOL PWD FOR SUSP 3.75GM/1 PACKET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001216", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-WELLBUTRIN SR 150MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003046", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-XALATAN OPHTH SOLN 0.005%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001194", "type": "CDM"}, {"code": "61314054701", "type": "NDC"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.97, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ZAFIRLUKAST ORAL TABLET 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001409", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ZIAC ORAL TABLET 10MG-6.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001804", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ZONEGRAN CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001818", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ZYPREXA 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002803", "type": "CDM"}, {"code": "43598016630", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-ZYPREXA 5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003023", "type": "CDM"}, {"code": "00904637761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Ziac Oral Tablet 10MG-6.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002101", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Ziac Oral Tablet 2.5MG-6.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003396", "type": "CDM"}, {"code": "00093324101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Zonegran Oral Capsule 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003893", "type": "CDM"}, {"code": "62756026002", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-Zosyn IV Solution 4.5GM/100ML", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J2543", "type": "HCPCS"}, {"code": "7003145", "type": "CDM"}, {"code": "64679001201", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.34, "maximum": 13.17, "gross_charge": 14.64, "discounted_cash": 54.17, "estimated_discounted_cash": 37.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF-aMILoride HCl/HCTZ Tablet 5MG-50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003644", "type": "CDM"}, {"code": "00378057701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.77, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-acetaZOLAMIDE Oral Tablet 125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003526", "type": "CDM"}, {"code": "51672402201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NF-rOPINIRole Hydrochloride Tablet 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003024", "type": "CDM"}, {"code": "43547027210", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NFCT AGENT DETECTION GI", "code_information": [{"code": "87505", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 147.53, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 147.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS CMV", "code_information": [{"code": "87910", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 296.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 296.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HEP B", "code_information": [{"code": "87912", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 296.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 296.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HEP C", "code_information": [{"code": "87902", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 296.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 296.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HIV1", "code_information": [{"code": "87906", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 148.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 148.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HIV1 REV", "code_information": [{"code": "87901", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 296.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 296.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS SARSCOV2", "code_information": [{"code": "87913", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT HIV GNRJ SEQ ALYS", "code_information": [{"code": "219U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "402U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "736T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "202U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "223U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM NEG", "code_information": [{"code": "142U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM POS", "code_information": [{"code": "141U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG ORG ID 6+", "code_information": [{"code": "86U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT QUAN ANTMCRB SC", "code_information": [{"code": "311U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT/VIRAL TRAIL IP10", "code_information": [{"code": "351U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV RNA VAG FLU ALG", "code_information": [{"code": "81513", "type": "CPT"}], "standard_charges": [{"minimum": 164.02, "maximum": 164.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 164.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS DNA ALG", "code_information": [{"code": "81514", "type": "CPT"}], "standard_charges": [{"minimum": 302.44, "maximum": 302.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 302.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS CHRNC HCV 6 ASSAYS", "code_information": [{"code": "81596", "type": "CPT"}], "standard_charges": [{"minimum": 83.02, "maximum": 83.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 83.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA UNTRGT NGNRJ SEQ", "code_information": [{"code": "152U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA&RNA 21 SARSCOV2", "code_information": [{"code": "225U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS FUNGI DNA 15 TRGT", "code_information": [{"code": "140U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS GU PTHGN ARG DETCJ", "code_information": [{"code": "372U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFCT DS STRN TYP WHL GEN SEQ", "code_information": [{"code": "10U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NFROS NFROT W/DRG", "code_information": [{"code": "50040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NG INTUBATION & LAVAGE", "code_information": [{"code": "43753", "type": "CPT"}, {"code": "11000072", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 425.49, "maximum": 2146.04, "gross_charge": 746.49, "discounted_cash": 54.17, "estimated_discounted_cash": 746.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 559.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 597.19, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 671.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 425.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NH WATER CUP", "code_information": [{"code": "3001448", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NI REHAB MED CHIRO", "code_information": [{"code": "M1143", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIACIN (NIASPAN) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000149", "type": "CDM"}, {"code": "00904227260", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NIACIN 250MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000784", "type": "CDM"}, {"code": "40985022849", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NICODERM CQ (NICOTINE) PATCH 14MG/24HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000300", "type": "CDM"}, {"code": "43598044774", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NICODERM CQ (NICOTINE) PATCH 21MG/24HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000248", "type": "CDM"}, {"code": "00536110888", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NICODERM CQ (NICOTINE) PATCH 7MG/24HR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000782", "type": "CDM"}, {"code": "43598044670", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NICOTINE LEVEL QUANTITATIVE", "code_information": [{"code": "80323", "type": "CPT"}, {"code": "1000833", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 124.2, "gross_charge": 138.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 110.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 124.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 78.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICOTINE PATCH LEGEND", "code_information": [{"code": "S4990", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NICOTINE PATCH NONLEGEND", "code_information": [{"code": "S4991", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC", "code_information": [{"code": "33782", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC W/OSTIA IMPLT", "code_information": [{"code": "33783", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIPPLE EXPLORATION", "code_information": [{"code": "19110", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIPPLE PROSTHESIS CUSTOM, EA", "code_information": [{"code": "L8033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIPRIDE RTU 50MG/100ML VIAL 100ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001048", "type": "CDM"}, {"code": "51754100601", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 336.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NITRO BID (NITRO) 2% OINT 1 INCH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000336", "type": "CDM"}, {"code": "00281032630", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NITROBLUE TETRAZOLIUM DYE", "code_information": [{"code": "86384", "type": "CPT"}], "standard_charges": [{"minimum": 15.65, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NITROGEN N-13 AMMONIA", "code_information": [{"code": "A9526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NITROGLYCERIN 50MG/10ML INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J2305", "type": "HCPCS"}, {"code": "7200081", "type": "CDM"}, {"code": "00517481025", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NITROGLYCERIN/D5W 0.2MG/ML 250ML", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J2305", "type": "HCPCS"}, {"code": "7000338", "type": "CDM"}, {"code": "00338104902", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NITROPRESS 25MG/ML INJ 2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000341", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NITROSTAT (NITROGLYCERIN) TAB 0.4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000342", "type": "CDM"}, {"code": "59762330403", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NIVESTYM", "code_information": [{"code": "Q5110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIZORAL (KETOCONAZOLE) 2% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000258", "type": "CDM"}, {"code": "51672129801", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NJX AA&/STRD AX NERVE IMG", "code_information": [{"code": "64417", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD BRCH PL NFS IMG", "code_information": [{"code": "64416", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD BRCH PLXS IMG", "code_information": [{"code": "64415", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEM NRV NFS IMG", "code_information": [{"code": "64448", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEMORAL NRV IMG", "code_information": [{"code": "64447", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD GNCLR NRV BRNCH", "code_information": [{"code": "64454", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD GR OCPL NRV", "code_information": [{"code": "64405", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD II IH NERVES", "code_information": [{"code": "64425", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD LMBR PLEX NFS", "code_information": [{"code": "64449", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NRV NRVTG SI JT", "code_information": [{"code": "64451", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NTRCOST NRV 1", "code_information": [{"code": "64420", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NTRCOST NRV EA", "code_information": [{"code": "64421", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PARACRV NRV", "code_information": [{"code": "64435", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PLTR COM DG NRV", "code_information": [{"code": "64455", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PUDENDAL NERVE", "code_information": [{"code": "64430", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SC NRV NFS IMG", "code_information": [{"code": "64446", "type": "CPT"}], "standard_charges": [{"minimum": 1636.8, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SCIATIC NRV IMG", "code_information": [{"code": "64445", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SPRSCAP NRV", "code_information": [{"code": "64418", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI C/T 1", "code_information": [{"code": "64479", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI C/T EA", "code_information": [{"code": "64480", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI L/S 1", "code_information": [{"code": "64483", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI L/S EA", "code_information": [{"code": "64484", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TRIGEMINAL NRV", "code_information": [{"code": "64400", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD VAGUS NRV", "code_information": [{"code": "64408", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX AUTOL WBC CONCENTRATE", "code_information": [{"code": "481T", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX B1 SUB MTRL SBCHDRL DFCT", "code_information": [{"code": "707T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH NSLC P-ART ANGRP", "code_information": [{"code": "93568", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV LV/LA ANG", "code_information": [{"code": "93565", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV RV/RA ANG", "code_information": [{"code": "93566", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SPRVLV AORTGRPHY", "code_information": [{"code": "93567", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P ANGRPH MAPCA", "code_information": [{"code": "93575", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P-ART ANGRP BI", "code_information": [{"code": "93573", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT PULM VN ANGRPH", "code_information": [{"code": "93574", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CATH SLCTV OPAC", "code_information": [{"code": "93564", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CTH SLCTV C ANG", "code_information": [{"code": "93563", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CHEMONUCLEOLYSIS LMBR", "code_information": [{"code": "62292", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CNTRST KNE ARTHG/CT/MRI", "code_information": [{"code": "27369", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX CTH SLCT P-ART ANGRP UNI", "code_information": [{"code": "93569", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62320", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62321", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62324", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62325", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62322", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62323", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62326", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62327", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT 1 VEIN", "code_information": [{"code": "36465", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT MLT VN", "code_information": [{"code": "36466", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "213T", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "214T", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "215T", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "216T", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "217T", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "218T", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PLATELET PLASMA", "code_information": [{"code": "232T", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PST CHMBR EYE MEDICATION", "code_information": [{"code": "699T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PX DISCOGRAPHY CRV/THRC", "code_information": [{"code": "62291", "type": "CPT"}], "standard_charges": [{"minimum": 1871.2, "maximum": 1871.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1871.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PX DISCOGRAPHY LUMBAR", "code_information": [{"code": "62290", "type": "CPT"}], "standard_charges": [{"minimum": 1871.2, "maximum": 1871.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1871.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50430", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50431", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX PX ONLY MAM DUCTO/GLCTO", "code_information": [{"code": "19030", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT 1 INCMPTNT VEIN", "code_information": [{"code": "36470", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT MLT INCMPTNT VN", "code_information": [{"code": "36471", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT SPIDER VEINS", "code_information": [{"code": "36468", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NJX STM CL PRDCT ANL SFT TIS", "code_information": [{"code": "748T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NL COMP CGEN KDN ABNORMALITY", "code_information": [{"code": "50070", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NL REMOVAL CALCULUS", "code_information": [{"code": "50060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NL RMVL LG STAGHORN CALCULUS", "code_information": [{"code": "50075", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NL SEC SURG OPERJ CALCULUS", "code_information": [{"code": "50065", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NMES DISPOSABLE", "code_information": [{"code": "A4560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO 1DOSE MENI VAC BTWN 11&13", "code_information": [{"code": "G9415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ADMIT REQ SURG REV", "code_information": [{"code": "G9413", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ADMIT W/IN 180D REQ REMOV", "code_information": [{"code": "G9411", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO AHI OR RDI INITIAL DX", "code_information": [{"code": "G8844", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ANTIBIO W IN 10D OF SYMPT", "code_information": [{"code": "G9287", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ANTIHIST/DECONG RX/RECOM", "code_information": [{"code": "4134F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ASA/ANTIPLAT THER USE RNG", "code_information": [{"code": "G8599", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ASPIRIN MED RSN", "code_information": [{"code": "G2128", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ASSESS BONE LOSS", "code_information": [{"code": "G8863", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO BONE SCN B/4 TXMNT/AFTRDX", "code_information": [{"code": "3270F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO BP MEASURE DOC", "code_information": [{"code": "G8756", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO BP OUTPT", "code_information": [{"code": "G2129", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO BRST CNCR DX MIN INVASIVE", "code_information": [{"code": "G8877", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO CARD TAMP E/IN 30D", "code_information": [{"code": "G9409", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO CAREGIVER", "code_information": [{"code": "G2184", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO CHAD OR CHAD SCR 0 OR 1", "code_information": [{"code": "G9931", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO COMBO PROHPYL THRP FOR PT", "code_information": [{"code": "G9958", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO CONFORMAL RADN THXPY", "code_information": [{"code": "4182F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO CONT PPI OR H2RA RCVD", "code_information": [{"code": "4186F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DEVICE W/DEV-INTENSIVE PX", "code_information": [{"code": "C1890", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC >1 DOSE REDUC TECH", "code_information": [{"code": "G9638", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC CHLAM SCR TS W/FOLLOW", "code_information": [{"code": "G9821", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC COMM RISK CALC", "code_information": [{"code": "G9317", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC COUNT OF CT IN 12MO", "code_information": [{"code": "G9322", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC CUR FUNCT ASSESS", "code_information": [{"code": "G8541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC ELDER MAL SCRN", "code_information": [{"code": "G8536", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC OF DSM-IV", "code_information": [{"code": "G9213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC ORDER ANTI-PLAT RNG", "code_information": [{"code": "G9611", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC SHARE DEC PRIOR PROC", "code_information": [{"code": "G9297", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC TYPE NSM LUNG CA", "code_information": [{"code": "G9290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOCUMNTD HBV RESULTS RCD", "code_information": [{"code": "G9915", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO EARLY IND/DELIVERY", "code_information": [{"code": "G9355", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ELECTRODIAG POLYNEURO 6MN", "code_information": [{"code": "3752F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ELIG REF FOR OTO EVAL", "code_information": [{"code": "G8857", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ELIG TPA INIT W/IN 4.5 HR", "code_information": [{"code": "G8601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO EVAL ACTIVITY CLIN SYMP", "code_information": [{"code": "3119F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO EVAL RISK VTE CARD PRIOR", "code_information": [{"code": "G9299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO F/U REC IMAGE STUDY", "code_information": [{"code": "G9548", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO FILT REMOV W/IN 3MOS PLCM", "code_information": [{"code": "G9544", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO FOLLOW UP PULM NOD NORSN", "code_information": [{"code": "G9347", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO FUNCT STAT PERF, RSN NOS", "code_information": [{"code": "G9918", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO HBV STATUS ASSESD AND INT", "code_information": [{"code": "G9913", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO HIST CD4+ CELL COUNT <350", "code_information": [{"code": "3493F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO HIST TYPE DOC ON REPORT", "code_information": [{"code": "G9284", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO HX SPIRO PRS SPIRO>=70%", "code_information": [{"code": "M1213", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO IMPR VIS ACUIT W/IN 90D", "code_information": [{"code": "G9517", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO IMPRO MED TIME PAIN MED", "code_information": [{"code": "G9427", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO IMPROVE VISUAL FUNCT", "code_information": [{"code": "G0915", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO INTERV REQ FOR LEAK", "code_information": [{"code": "G9305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO LOW PECARN PED HEAD TRAUM", "code_information": [{"code": "G9597", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO MED VISIT IN 24MO", "code_information": [{"code": "G9246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO MPM", "code_information": [{"code": "G2150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO MPM MED RSN", "code_information": [{"code": "G2149", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO MRS 90 DAYS POST STK", "code_information": [{"code": "G0046", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO NECK FS PROM INCAP", "code_information": [{"code": "M1149", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO NECK FS PROM NO RSN", "code_information": [{"code": "G2210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO OFF ASSIS EOL", "code_information": [{"code": "G9382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PAP PRESCRIBED", "code_information": [{"code": "G8850", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PCV RECD", "code_information": [{"code": "M1179", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PHARM THER OSTEO RX", "code_information": [{"code": "G8635", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PNEUM VAX ADMIN 19+", "code_information": [{"code": "M1304", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PNEUMOCOCCAL ADMIN", "code_information": [{"code": "G8867", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO POSTOP REN FAIL", "code_information": [{"code": "G8576", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PROL INTUB REQ", "code_information": [{"code": "G8570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PT CARE ICU/VENT IN 24HRS", "code_information": [{"code": "4169F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PT CATEGORY ON REPORT", "code_information": [{"code": "G9293", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PT TBCO CESS INTERV RNG", "code_information": [{"code": "G9908", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PT TBCO CESS INTERV RNG", "code_information": [{"code": "M1289", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PT TBCO SCRN RNG", "code_information": [{"code": "G9905", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PT TBCO SCRN RNG", "code_information": [{"code": "M1312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO QUAL CARD DIAG PRIOR12MON", "code_information": [{"code": "1461F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO REAS, NO RET OR W/IN 90D", "code_information": [{"code": "G9515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO REC CORTICO>60D 1RX 600MG", "code_information": [{"code": "G9470", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RECD CORTICO>=10MG/D >60D", "code_information": [{"code": "G9468", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO REOP REQ BLD GRFT OTH", "code_information": [{"code": "G8578", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RET FOR SURG W IN 30D", "code_information": [{"code": "G9307", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RSK FAC OR 1 MOD RISK TE", "code_information": [{"code": "G8970", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RSN ACE ARB ARNI", "code_information": [{"code": "G2096", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RSN ACE-I/ARB RX", "code_information": [{"code": "M1203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RSN NO BRIEF COUNS", "code_information": [{"code": "G2202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RX ACE/ARB THERAPY", "code_information": [{"code": "G8937", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SATISFY WITH CARE", "code_information": [{"code": "G0918", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SCRN PROV RSN NOS", "code_information": [{"code": "G9925", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SENT LYMPH NODE BIOPSY", "code_information": [{"code": "G8882", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SIG DEP SYMP BY DEP TOOL", "code_information": [{"code": "3352F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SIGNS MELANOMA", "code_information": [{"code": "G8749", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SLEEP APNEA ASSESS", "code_information": [{"code": "G8841", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SMOK B/4 ANES DAY OF SURG", "code_information": [{"code": "G9644", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SPIRO DOC NO RES DOC", "code_information": [{"code": "M1216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SRCH FOR CT IN 12MO NORSN", "code_information": [{"code": "G9342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO STATIN/NO ORDER STATIN", "code_information": [{"code": "G9665", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SURG SITE INFECTION", "code_information": [{"code": "G9311", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SYST ANTIMICROBIAL THX RX", "code_information": [{"code": "4132F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TA TV ULTRASND", "code_information": [{"code": "G8807", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TOB SCR/CESS INT", "code_information": [{"code": "G0029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TOB SCR/CESS INT", "code_information": [{"code": "M1313", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TPA INIT W/IN 4.5 HR", "code_information": [{"code": "G8602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TRANSFERCARE CHKLIST USED", "code_information": [{"code": "584F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TRNSFR FROM ANESTH TO CC", "code_information": [{"code": "582F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TRTMT CHEMO AND HER2", "code_information": [{"code": "G2208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO UNHEAL ETOH USER", "code_information": [{"code": "G9622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO UNPLND HOSP READM IN 30D", "code_information": [{"code": "G9309", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO WARF OR FDA DRUG PRESC", "code_information": [{"code": "G9928", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO WELL-CHLD VIST RECV BY PT", "code_information": [{"code": "G9965", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO WET-DRY DRSSINGS RX RECMD", "code_information": [{"code": "4266F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO XRAY/CT/ ET AL ORDD", "code_information": [{"code": "3320F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOC RETAIL ITEMS ANDSUPPLIES", "code_information": [{"code": "T1999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOCARDIA ANTIBODY", "code_information": [{"code": "86744", "type": "CPT"}], "standard_charges": [{"minimum": 18.39, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NODE NEG PRE/POST SYST THER", "code_information": [{"code": "G9911", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON CORING NEEDLE OR STYLET", "code_information": [{"code": "A4212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON CUTANEOUS LOC", "code_information": [{"code": "G9295", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-AUTO GRAFT 1ST TOOTH", "code_information": [{"code": "D4275", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-AUTO GRAFT ADDL TOOTH", "code_information": [{"code": "D4285", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [{"code": "98", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [{"code": "97", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "99", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-BLIND INTERATRIAL SHUNT", "code_information": [{"code": "C9760", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-COV PROC, CLINICAL TRIAL", "code_information": [{"code": "G0294", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-COV SURG PROC,CLIN TRIAL", "code_information": [{"code": "G0293", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-COVERED ITEM OR SERVICE", "code_information": [{"code": "A9270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-ELASTIC EXTREMITY BINDER", "code_information": [{"code": "A4465", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-ELECTRONIC SPIROMETER", "code_information": [{"code": "A9284", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-EMER TRANSPORT WAIT TIME", "code_information": [{"code": "T2007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE BURNS", "code_information": [{"code": "935", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "988", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "987", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "989", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-HEU TC-99M ADD-ON/DOSE", "code_information": [{"code": "Q9969", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-IMAGING HEART FUNCTION", "code_information": [{"code": "78414", "type": "CPT"}], "standard_charges": [{"minimum": 89.6, "maximum": 89.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-INHALATION DRUG FOR DME", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7799", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-IONIZING DIAG PROC", "code_information": [{"code": "D0600", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITH CC/MCC", "code_information": [{"code": "600", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "601", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NON-OPHTHALMIC FVA", "code_information": [{"code": "C9733", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-OSSEOINTEGRATED SND PROC", "code_information": [{"code": "L8692", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-PRSCRP LENS", "code_information": [{"code": "S0510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-PVC INTRAVENOUS ADMINIST", "code_information": [{"code": "S1016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-RAD CONTRAST MATERIALNOC", "code_information": [{"code": "A9698", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-ROUTINE BL DRAW 3/> YRS", "code_information": [{"code": "36410", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-SPEECH DEVICE SERVICE", "code_information": [{"code": "92606", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-STERILE GAUZE > 48 SQ IN", "code_information": [{"code": "A6218", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-STERILE GLOVES", "code_information": [{"code": "A4927", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-SURG TX ROOT CANAL OBS", "code_information": [{"code": "D3331", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-SURGICAL SIALOLITHOTOMY", "code_information": [{"code": "D7979", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONCOVERED AMBULANCE MILEAGE", "code_information": [{"code": "A0888", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONDISP UNDERPADS, ALL SIZES", "code_information": [{"code": "A4553", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONDOT 5PANEL BLOOD", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "1001003", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 71.46, "maximum": 268.2, "gross_charge": 298.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 71.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 238.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 268.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 169.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONEMERG TRANSP MILEAGE", "code_information": [{"code": "S0215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONEMERGENCY TRANSPORT AIR", "code_information": [{"code": "A0140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONEMERGENCY TRANSPORT BUS", "code_information": [{"code": "A0110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONEMERGENCY TRANSPORT TAXI", "code_information": [{"code": "A0100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONER TRANSPORT CASE WORKER", "code_information": [{"code": "A0160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONER TRANSPORT LODGNG ESCRT", "code_information": [{"code": "A0200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONER TRANSPORT LODGNG RECIP", "code_information": [{"code": "A0180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONER TRANSPORT MEALS ESCORT", "code_information": [{"code": "A0210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONER TRANSPORT MEALS RECIP", "code_information": [{"code": "A0190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONER TRANSPORT MINI-BUS", "code_information": [{"code": "A0120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONER TRANSPORT WHEELCH VAN", "code_information": [{"code": "A0130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONFAMILY HC TRAIN/SESSION", "code_information": [{"code": "S5116", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONFAMILY HOMECARE TRAIN/15M", "code_information": [{"code": "S5115", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONINTEREST ESCORT IN NON ER", "code_information": [{"code": "A0080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONINVAS RESP SUPPORT TALK", "code_information": [{"code": "4550F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONMED FAMILY PLANNING ED", "code_information": [{"code": "H1010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONNEEDLE INJECTION DEVICE", "code_information": [{"code": "A4210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONPRIM LOC ANAT BX SITE TUM", "code_information": [{"code": "3250F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [{"code": "71", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [{"code": "70", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "72", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [{"code": "67", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC", "code_information": [{"code": "68", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NONSTND LENS", "code_information": [{"code": "S0581", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONTHERM ELECTROMGNTC DEVICE", "code_information": [{"code": "E0761", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NONTRAUMATIC STUPOR AND COMA WITH MCC", "code_information": [{"code": "80", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [{"code": "81", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NONVASCULAR SHUNT X-RAY", "code_information": [{"code": "75809", "type": "CPT"}], "standard_charges": [{"minimum": 104.59, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 104.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOONAN SPECTRUM DISORDERS", "code_information": [{"code": "81442", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 2465.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2465.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NORCO (HYRDOCOD/APAP) TAB 10/325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000985", "type": "CDM"}, {"code": "53746011001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NORCO (HYRDOCOD/APAP) TAB 5/325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000930", "type": "CDM"}, {"code": "10702018901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NORCO (HYRDOCOD/APAP) TAB 7.5/325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000986", "type": "CDM"}, {"code": "27808003601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NORCURON (VECURONIUM BROMIDE) 10MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000939", "type": "CDM"}, {"code": "55150023510", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NORMADYNE (LABETALOL HCL) INJ 20MG/4ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1920", "type": "HCPCS"}, {"code": "72001130", "type": "CDM"}, {"code": "25021031720", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 10.73, "maximum": 16.95, "gross_charge": 18.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORMAL NEWBORN", "code_information": [{"code": "795", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NORML GEL WOUND DRESSING", "code_information": [{"code": "3000526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NORMODYNE (LABETALOL) 100MG INJ", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J1920", "type": "HCPCS"}, {"code": "7000262", "type": "CDM"}, {"code": "25021031720", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORMODYNE (LABETALOL) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000263", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NOROVIRUS / NORWALK", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "1000695", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 40.35, "maximum": 186.97, "gross_charge": 207.75, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 166.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 186.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 118.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORPACE (DISOPYRAMIDE) CAP 150MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000788", "type": "CDM"}, {"code": "00093312901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NORSN FOR GC CHL SYP TEST", "code_information": [{"code": "G9230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NORSN NO FOOT EXAM", "code_information": [{"code": "G9225", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NORSN NOT FIRST LINE AMOX", "code_information": [{"code": "G9314", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NORVASC (AMLODIPINE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000343", "type": "CDM"}, {"code": "00904637161", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NORVASC (AMLODIPINE) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001042", "type": "CDM"}, {"code": "00904636961", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NORVASC (AMLODIPINE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000344", "type": "CDM"}, {"code": "69097012705", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NOS QUANT SENSORY TEST", "code_information": [{"code": "110T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOSE ALLERGY TEST", "code_information": [{"code": "95065", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOSE TRAY", "code_information": [{"code": "3000255", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NOT >1 SINUS CT W 90D DX", "code_information": [{"code": "G9352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT DISCH HOME BY DAY #2", "code_information": [{"code": "G8838", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT ELG PRE EX IBD/UC/CROHN", "code_information": [{"code": "M1182", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT INITIAL EVAL FOR COND", "code_information": [{"code": "1501F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT MEDICALLY NECESSARY SVC", "code_information": [{"code": "S9986", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT NSM LUNG CA", "code_information": [{"code": "G9291", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT PRES ANTIBIOTIC", "code_information": [{"code": "G8712", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT REF FOR OTO EVAL", "code_information": [{"code": "G8858", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT SCRN ETOH NO RSN", "code_information": [{"code": "G2199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOTE HRING TST W/IN 6 MON", "code_information": [{"code": "3230F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOVACHOR 1 SQ CM", "code_information": [{"code": "Q4194", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOVAFIX DL PER SQ CM", "code_information": [{"code": "Q4254", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOVAFIX PER SQ CM", "code_information": [{"code": "Q4208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOVOLOG INSULIN 70/30 100 UNITS/ML", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "72000525", "type": "CDM"}, {"code": "00169368512", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.9, "gross_charge": 1.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOVOLOG MIX 70/30 FLEXPEN SUBQ SUSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001046", "type": "CDM"}, {"code": "00169369619", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NOVOSORB SYNPATH PER SQ CM", "code_information": [{"code": "A2006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NPM1 GENE", "code_information": [{"code": "81310", "type": "CPT"}], "standard_charges": [{"minimum": 283.5, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 283.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NPM1 GENE ANALYSIS QUAN", "code_information": [{"code": "49U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NPO (NOTHING-MOUTH) ORDERED", "code_information": [{"code": "6020F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE BI", "code_information": [{"code": "69706", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE UNI", "code_information": [{"code": "69705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRAS GENE VARIANTS EXON 2&3", "code_information": [{"code": "81311", "type": "CPT"}], "standard_charges": [{"minimum": 340.16, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 340.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRPSYC GEN SEQ VRNT ALY 13", "code_information": [{"code": "419U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96132", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP EA", "code_information": [{"code": "96133", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 11-12 STUDIES", "code_information": [{"code": "95912", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 13/> STUDIES", "code_information": [{"code": "95913", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 7-8 STUDIES", "code_information": [{"code": "95910", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 9-10 STUDIES", "code_information": [{"code": "95911", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TST 3-4 STUDIES", "code_information": [{"code": "95908", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TST 5-6 STUDIES", "code_information": [{"code": "95909", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG <4CM", "code_information": [{"code": "64892", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG >4 CM", "code_information": [{"code": "64893", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT <4CM", "code_information": [{"code": "64890", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT >4CM", "code_information": [{"code": "64891", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG <4 CM", "code_information": [{"code": "64897", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG >4 CM", "code_information": [{"code": "64898", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT <4 CM", "code_information": [{"code": "64895", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT >4 CM", "code_information": [{"code": "64896", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT 1ST", "code_information": [{"code": "64912", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT EA ADDL", "code_information": [{"code": "64913", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSG AIDE SERVICE UP TO 15MIN", "code_information": [{"code": "T1004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX MAX SINUSC", "code_information": [{"code": "31233", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX SPHN SINUSC", "code_information": [{"code": "31235", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC FRNT TISS RMVL", "code_information": [{"code": "31276", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED&INF DCMPRN", "code_information": [{"code": "31293", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED/INF DCMPRN", "code_information": [{"code": "31292", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SPHN TISS RMVL", "code_information": [{"code": "31259", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SRG NSL HEMRRG", "code_information": [{"code": "31238", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG BX POLYPC", "code_information": [{"code": "31237", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT SINS", "code_information": [{"code": "31296", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT&SPHN", "code_information": [{"code": "31298", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG MAX SINS", "code_information": [{"code": "31295", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG ON DCMPRN", "code_information": [{"code": "31294", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG SPHN SINS", "code_information": [{"code": "31297", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOT W/SPHENDT", "code_information": [{"code": "31257", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOTAL", "code_information": [{"code": "31253", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/PRTL ETHMDCT", "code_information": [{"code": "31254", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/TOT ETHMDCT", "code_information": [{"code": "31255", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS ENDOSCOPY SURG DCR", "code_information": [{"code": "31239", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC CRYOABLTJ PNN", "code_information": [{"code": "31243", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC RF ABLTJ PNN", "code_information": [{"code": "31242", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC CNCH BULL RESCJ", "code_information": [{"code": "31240", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC LIG SPHNPTN ART", "code_information": [{"code": "31241", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTIOL CATEGORY 4", "code_information": [{"code": "Q1004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTIOL CATEGORY 5", "code_information": [{"code": "Q1005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRAOP HIPEC PX EA ADD 30MIN", "code_information": [{"code": "96548", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRAPX C FFR W/3D FUNCJL MAP", "code_information": [{"code": "523T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRK TRANSLOCATION ANALYSIS", "code_information": [{"code": "81194", "type": "CPT"}], "standard_charges": [{"minimum": 596.02, "maximum": 596.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 596.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRK1 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81191", "type": "CPT"}], "standard_charges": [{"minimum": 238.41, "maximum": 238.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRK2 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81192", "type": "CPT"}], "standard_charges": [{"minimum": 238.41, "maximum": 238.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRK3 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81193", "type": "CPT"}], "standard_charges": [{"minimum": 238.41, "maximum": 238.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 11-20", "code_information": [{"code": "99447", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 21-30", "code_information": [{"code": "99448", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 31/>", "code_information": [{"code": "99449", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 5-10", "code_information": [{"code": "99446", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 5/>", "code_information": [{"code": "99451", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR RFRL", "code_information": [{"code": "99452", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR CPLX", "code_information": [{"code": "77386", "type": "CPT"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR SMPL", "code_information": [{"code": "77385", "type": "CPT"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUBAIN (NALBUPHINE) 10MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2300", "type": "HCPCS"}, {"code": "7000327", "type": "CDM"}, {"code": "00409146301", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUBAIN (NALBUPHINE) 20MG/ML", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J2300", "type": "HCPCS"}, {"code": "72000557", "type": "CDM"}, {"code": "00409146501", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHY/QHP EA ADDL HR", "code_information": [{"code": "96121", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHYS/QHP 1ST HR", "code_information": [{"code": "96116", "type": "CPT"}], "standard_charges": [{"minimum": 1848.13, "maximum": 1848.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1848.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLEAR EXAM OF TEAR FLOW", "code_information": [{"code": "78660", "type": "CPT"}], "standard_charges": [{"minimum": 221.91, "maximum": 221.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 221.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLEAR MATRIX PROTEIN 22", "code_information": [{"code": "86386", "type": "CPT"}], "standard_charges": [{"minimum": 25.05, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRA-ARTERIAL", "code_information": [{"code": "79445", "type": "CPT"}], "standard_charges": [{"minimum": 254.38, "maximum": 996.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 254.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 996.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRA-ARTICULAR", "code_information": [{"code": "79440", "type": "CPT"}], "standard_charges": [{"minimum": 158.58, "maximum": 996.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 158.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 996.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRACAV ADMIN", "code_information": [{"code": "79200", "type": "CPT"}], "standard_charges": [{"minimum": 174.76, "maximum": 996.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 174.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 996.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX IV ADMIN", "code_information": [{"code": "79101", "type": "CPT"}], "standard_charges": [{"minimum": 190.03, "maximum": 996.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 190.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 996.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX ORAL ADMIN", "code_information": [{"code": "79005", "type": "CPT"}], "standard_charges": [{"minimum": 175.52, "maximum": 996.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 175.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 996.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUCLR RX INTERSTIT COLLOID", "code_information": [{"code": "79300", "type": "CPT"}], "standard_charges": [{"minimum": 139.16, "maximum": 996.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 139.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 996.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUDT15 GENE COMMON VARIANTS", "code_information": [{"code": "81306", "type": "CPT"}], "standard_charges": [{"minimum": 335.06, "maximum": 335.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 335.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUDT15&TPMT GENE COM VRNT", "code_information": [{"code": "169U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUDYN DL OR DL MESH PR SQ CM", "code_information": [{"code": "Q4285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUDYN SL OR SLW, PER SQ CM", "code_information": [{"code": "Q4286", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUPERCAINAL (DIBUCAINE) 1% OINT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000345", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NURSE PRACTR VISIT OUTS CAP", "code_information": [{"code": "S0274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NURSING ASSESSMENT/EVALUATN", "code_information": [{"code": "T1001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NURSING CARE IN HOME RN", "code_information": [{"code": "S9123", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NURSING CARE, IN THE HOME; B", "code_information": [{"code": "S9124", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99379", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUSHIELD 1 SQUARE CM", "code_information": [{"code": "Q4160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUTRI COUNSEL-CONTROL CARIES", "code_information": [{"code": "D1310", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUTRITION CLASS", "code_information": [{"code": "S9452", "type": "HCPCS"}], "standard_charges": [{"minimum": 627.29, "maximum": 627.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 627.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUTRITION/DIETICIAN SS", "code_information": [{"code": "G4017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUTRITIONAL COUNSELING, DIET", "code_information": [{"code": "S9470", "type": "HCPCS"}], "standard_charges": [{"minimum": 627.29, "maximum": 627.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 627.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUTRITIONAL SUPPORT OFFERED", "code_information": [{"code": "4551F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NVR CNDJ TST 1-2 STUDIES", "code_information": [{"code": "95907", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NY HEART ASSOC CLASS DOCD", "code_information": [{"code": "3118F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NYSTATIN CREAM 100,000MU/GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000346", "type": "CDM"}, {"code": "45802005935", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NYSTATIN ORAL SUSP 500,000UNITS/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000347", "type": "CDM"}, {"code": "00904727670", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NYSTATIN POWDER 100,000U/GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000348", "type": "CDM"}, {"code": "00832046560", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 55.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NeoGuard, per square centimeter", "code_information": [{"code": "Q4371", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nephrology (renal transplant), quantification of CXCL10 chemokines, flow cytometry, urine, reported as pg/mL creatinine baseline and monitoring over time", "code_information": [{"code": "526U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nephrology (renal transplant), urine, nuclear magnetic resonance (NMR) spectroscopy measurement of 84 urinary metabolites, combined with patient data, quantification of BK virus (human polyomavirus 1) using real-time PCR and serum creatinine, algorithm re", "code_information": [{"code": "542U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nerve cryoablation probe (e.g., cryoICE, cryoSPHERE, cryoSPHERE MAX, cryoICE cryoSPHERE, cryoICE cryO2), including probe and all disposable system components, non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surg", "code_information": [{"code": "C9808", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nerve stimulator, percutaneous, peripheral (e.g., SPRINT peripheral nerve stimulation system), including electrode and all disposable system components, non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical p", "code_information": [{"code": "C9807", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Neurofilament light chain (NfL)", "code_information": [{"code": "83884", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Neurofilament light chain (NfL), chemiluminescent enzyme immunoassay, plasma, quantitative", "code_information": [{"code": "547U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Neurofilament light chain (NfL), ultra-sensitive immunoassay, serum or cerebrospinal fluid", "code_information": [{"code": "443U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Neurology (Alzheimer disease), beta amyloid (A\u03b240, A\u03b242, A\u03b242/40 ratio) and tau-protein (ptau217, np-tau217, ptau217/np-tau217 ratio), blood, immunoprecipitation with quantitation by liquid chromatography with tandem mass spectrometry (LC-MS/MS), algorith", "code_information": [{"code": "503U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Neurology (dementia), beta amyloid (A\u03b240, A\u03b242, A\u03b242/40 ratio), tau-protein phosphorylated at residue (eg, pTau217), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP), by ultra-high sensitivity molecule array detection, plasma, a", "code_information": [{"code": "568U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Neurology (traumatic brain injury), analysis of glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), immunoassay, whole blood or plasma, individual components reported with the overall result of elevated or non-ele", "code_information": [{"code": "570U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Neuromod adj rehab mouthpie", "code_information": [{"code": "A4594", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Neuromod sti sys adj rehab", "code_information": [{"code": "A4593", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Niferex Forte-150 Oral Capsule", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003852", "type": "CDM"}, {"code": "75854032130", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 39.63, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Non-pneumatic, non-sequential, peristaltic wave compression pump", "code_information": [{"code": "E0683", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Noninvasive assessment of blood oxygenation, gas exchange efficiency, and cardiorespiratory status, with physician or other qualified health care professional interpretation and report", "code_information": [{"code": "893T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Noninvasive augmentative arrhythmia analysis derived from quantitative computational cardiac arrhythmia simulations, based on selected intervals of interest from 12-lead electrocardiogram and uploaded clinical parameters, including uploading clinical para", "code_information": [{"code": "897T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Noninvasive detection of heart failure derived from augmentative analysis of an echocardiogram that demonstrated preserved ejection fraction, with interpretation and report by a physician or other qualified health care professional", "code_information": [{"code": "932T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Noninvasive determination of absolute quantitation of myocardial blood flow (AQMBF), derived from augmentative algorithmic analysis of the dataset acquired via contrast cardiac magnetic resonance (CMR), pharmacologic stress, with interpretation and report", "code_information": [{"code": "899T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Noninvasive estimate of absolute quantitation of myocardial blood flow (AQMBF), derived from assistive algorithmic analysis of the dataset acquired via contrast cardiac magnetic resonance (CMR), pharmacologic stress, with interpretation and report by a ph", "code_information": [{"code": "900T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Noninvasive prostate cancer estimation map, derived from augmentative analysis of image-guided fusion biopsy and pathology, including visualization of margin volume and location, with margin determination and physician interpretation and report", "code_information": [{"code": "898T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "O&P SUPPLY/ACCESSORY/SERVICE", "code_information": [{"code": "L9900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [{"code": "620", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [{"code": "619", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC", "code_information": [{"code": "621", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC", "code_information": [{"code": "940", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [{"code": "939", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC", "code_information": [{"code": "941", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [{"code": "876", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "O2 CONTENTS GAS CUBIC FT", "code_information": [{"code": "S8120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "O2 CONTENTS LIQUID LB", "code_information": [{"code": "S8121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "O2 FLOW REG POS INSPIR PRESS", "code_information": [{"code": "E1352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "O2 SATURATION >88%/PAO>55 HG", "code_information": [{"code": "3037F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "O2 SATURATION DOC REV", "code_information": [{"code": "3028F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "O2 SATURATION<=88%/PAO<=55", "code_information": [{"code": "3035F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OASIS BURN MATRIX", "code_information": [{"code": "Q4103", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OASIS TRI-LAYER WOUND MATRIX", "code_information": [{"code": "Q4124", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OASIS WOUND MATRIX", "code_information": [{"code": "Q4102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB PACK", "code_information": [{"code": "3000527", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OB PE BIOCHEM ASSAY PGF ALG", "code_information": [{"code": "243U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB PE KDR ENG&RBP4 IA ALG", "code_information": [{"code": "390U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB PREIMPLTJ TST 300000 DNA", "code_information": [{"code": "404U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB PRTRM BRTH IBP4 SHBG MEAS", "code_information": [{"code": "247U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB US < 14 WKS ADDL FETUS", "code_information": [{"code": "76802", "type": "CPT"}], "standard_charges": [{"minimum": 79.91, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 79.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB US >= 14 WKS ADDL FETUS", "code_information": [{"code": "76810", "type": "CPT"}], "standard_charges": [{"minimum": 114.31, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 114.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB US DETAILED ADDL FETUS", "code_information": [{"code": "76812", "type": "CPT"}], "standard_charges": [{"minimum": 249.24, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 249.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB US DETAILED SNGL FETUS", "code_information": [{"code": "76811", "type": "CPT"}], "standard_charges": [{"minimum": 225.42, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 225.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB US FOLLOW-UP PER FETUS", "code_information": [{"code": "76816", "type": "CPT"}], "standard_charges": [{"minimum": 141.01, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 141.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS 1 GEST", "code_information": [{"code": "76813", "type": "CPT"}], "standard_charges": [{"minimum": 152.7, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 152.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS ADD-ON", "code_information": [{"code": "76814", "type": "CPT"}], "standard_charges": [{"minimum": 99.02, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 99.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB XPND CAR SCR 145 GENES", "code_information": [{"code": "413U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB XPND CAR SCR 145 GENES", "code_information": [{"code": "414U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB/GYN SS", "code_information": [{"code": "G4018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OBINUTUZUMAB INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9301", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OBS CO2 DETERMINATION CONTINUOUS", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "11000264", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 166.12, "maximum": 368.06, "gross_charge": 408.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 306.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 327.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 368.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 233.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS CONTINUOUS PULSE OXIMETRY", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "11000262", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 166.12, "maximum": 368.06, "gross_charge": 408.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 306.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 327.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 368.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 233.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS IMMUNIZATION ADM1ST DOSE-NASL/ORAL", "code_information": [{"code": "90473", "type": "CPT"}, {"code": "11000267", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 157.14, "gross_charge": 174.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS IMMUNIZATION ADMI-ADL DOSE-NASL/ORAL", "code_information": [{"code": "90474", "type": "CPT"}, {"code": "11000268", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 20.29, "maximum": 122.64, "gross_charge": 35.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS IMMUNIZATION ADMIN <18 W/MD", "code_information": [{"code": "90460", "type": "CPT"}, {"code": "11000273", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 39.79, "maximum": 122.64, "gross_charge": 69.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 52.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 55.84, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 62.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 39.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS IMMUNIZATION ADMIN <18 W/MD ADDL", "code_information": [{"code": "90461", "type": "CPT"}, {"code": "11000274", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 20.29, "maximum": 122.64, "gross_charge": 35.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS IMMUNIZATION ADMIN-1ST INJECTION", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "11000265", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 157.14, "gross_charge": 174.6, "discounted_cash": 54.17, "estimated_discounted_cash": 174.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS IMMUNIZATION ADMIN-ADDL INJECTION", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "11000266", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 46.18, "maximum": 122.64, "gross_charge": 81.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 60.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.82, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 122.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS INSERT INDWELL BLADDER CATH TECH", "code_information": [{"code": "51702", "type": "CPT"}, {"code": "11000288", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "estimated_discounted_cash": 315.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS PULSE OXIMETRY MULTIPLE DETER", "code_information": [{"code": "94761", "type": "CPT"}, {"code": "11000272", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 7.42, "maximum": 11.71, "gross_charge": 13.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 10.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 7.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS PULSE OXIMETRY SINGLE DETERMINATION", "code_information": [{"code": "94760", "type": "CPT"}, {"code": "11000263", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 6.87, "maximum": 10.85, "gross_charge": 12.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSERVATION ADMIT (LOW COMPLEX)", "code_information": [{"code": "99221", "type": "CPT"}, {"code": "10000006", "type": "CDM"}, {"code": "760", "type": "RC"}], "standard_charges": [{"minimum": 161.64, "maximum": 255.23, "gross_charge": 283.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 226.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 255.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 161.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSERVATION ADMIT (MOD COMPLEX)", "code_information": [{"code": "99222", "type": "CPT"}, {"code": "10000007", "type": "CDM"}, {"code": "760", "type": "RC"}], "standard_charges": [{"minimum": 220.52, "maximum": 348.19, "gross_charge": 386.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 290.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 309.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 348.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 220.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSERVATION DIRECT ADMIT", "code_information": [{"code": "G0379", "type": "HCPCS"}, {"code": "10000015", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 441.75, "maximum": 697.5, "gross_charge": 775.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 581.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 441.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSERVATION DISCHARGE (ER PHYS)", "code_information": [{"code": "99238", "type": "CPT"}, {"code": "11200003", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 107.61, "maximum": 169.91, "gross_charge": 188.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 141.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 151.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 169.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 107.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSERVATION FEE PER HOUR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "10000009", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 30.87, "maximum": 2571.16, "gross_charge": 54.17, "discounted_cash": 54.17, "estimated_discounted_cash": 1541.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 43.33, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2571.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80055", "type": "CPT"}], "standard_charges": [{"minimum": 26.51, "maximum": 54.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80081", "type": "CPT"}], "standard_charges": [{"minimum": 26.51, "maximum": 86.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 86.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59409", "type": "CPT"}], "standard_charges": [{"minimum": 6928.28, "maximum": 6928.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59410", "type": "CPT"}], "standard_charges": [{"minimum": 6928.28, "maximum": 6928.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OBTAINING SCREEN PAP SMEAR", "code_information": [{"code": "Q0091", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1109", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1114", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1119", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1129", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC", "code_information": [{"code": "M1133", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT DC 1-2 VIS", "code_information": [{"code": "M1124", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1118", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1123", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1128", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT HOME PROG", "code_information": [{"code": "M1132", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC", "code_information": [{"code": "M1115", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC", "code_information": [{"code": "M1120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC", "code_information": [{"code": "M1130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC", "code_information": [{"code": "M1134", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NI PT SELFDC 1-2 VIS", "code_information": [{"code": "M1125", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OC NOT P PT SELFDC", "code_information": [{"code": "M1110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCC GUARD, HARD, FULL ARCH", "code_information": [{"code": "D9944", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCC GUARD, HARD, PART ARCH", "code_information": [{"code": "D9946", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCC GUARD, SOFT, FULL ARCH", "code_information": [{"code": "D9945", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCC ORTHOTIC DEVICE ADJUST", "code_information": [{"code": "D7881", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCIP HDACHE CHILD", "code_information": [{"code": "G2195", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCLUDE FALLOPIAN TUBE(S)", "code_information": [{"code": "58615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCLUSAL GUARD ADJUSTMENT", "code_information": [{"code": "D9943", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCLUSAL ORTHOTIC APPLIANCE", "code_information": [{"code": "D7880", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCLUSION ANALYSIS", "code_information": [{"code": "D9950", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCLUSIVE DEVICE IN VEIN ART", "code_information": [{"code": "G0269", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCLUSIVE EYE PATCH", "code_information": [{"code": "A6412", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD #2", "code_information": [{"code": "82271", "type": "CPT"}, {"code": "1099012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.12, "maximum": 17.33, "gross_charge": 19.26, "discounted_cash": 54.17, "estimated_discounted_cash": 22.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 17.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD #3", "code_information": [{"code": "82271", "type": "CPT"}, {"code": "1099013", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.12, "maximum": 17.33, "gross_charge": 19.26, "discounted_cash": 54.17, "estimated_discounted_cash": 22.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 17.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD FECES", "code_information": [{"code": "82270", "type": "CPT"}], "standard_charges": [{"minimum": 5.04, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD STOOL", "code_information": [{"code": "82272", "type": "CPT"}, {"code": "1000044", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.86, "maximum": 17.33, "gross_charge": 19.26, "discounted_cash": 54.17, "estimated_discounted_cash": 19.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 17.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD TEST STRIPS", "code_information": [{"code": "A4773", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCUPATIONAL THERAPY, IN THE", "code_information": [{"code": "S9129", "type": "HCPCS"}], "standard_charges": [{"minimum": 589.34, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCT BREAST SURG CAVITY I&R", "code_information": [{"code": "354T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCT BRST/NODE I&R PER SPEC", "code_information": [{"code": "352T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R BILATERAL", "code_information": [{"code": "486T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R UNILATERAL", "code_information": [{"code": "485T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCTAGAM 5% 10GM/200ML", "drug_information": {"unit": 40.0, "type": "EA"}, "code_information": [{"code": "J1568", "type": "HCPCS"}, {"code": "72000980", "type": "CDM"}, {"code": "68982085004", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 912.0, "maximum": 7308.2, "gross_charge": 1600.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1280.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCTAGAM 5% 5GM/100ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1460", "type": "HCPCS"}, {"code": "72000981", "type": "CDM"}, {"code": "68982084003", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 456.0, "maximum": 720.0, "gross_charge": 800.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 640.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCTREOTIDE INJ, NON-DEPOT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCTREOTIDE INJECTION, DEPOT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2353", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR BLOOD FLOW MEASURE", "code_information": [{"code": "198T", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR DEV, INTRAOP, DET RET", "code_information": [{"code": "C1784", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR FUNCTION SCREEN", "code_information": [{"code": "99172", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR IMP, AQUEOUS DRAIN DE", "code_information": [{"code": "C1783", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99174", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99177", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR PHOTODYNAMIC THER", "code_information": [{"code": "67221", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR PROSTHESIS", "code_information": [{"code": "D5916", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR PROSTHESIS INTERIM", "code_information": [{"code": "D5923", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65780", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65781", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65782", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ODONTICS ENDOSTEAL IMPLANT", "code_information": [{"code": "D6010", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ODONTICS EPOSTEAL IMPLANT", "code_information": [{"code": "D6040", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ODONTICS TRANSOSTEAL IMPLNT", "code_information": [{"code": "D6050", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ODONTOPLASTY PER TOOTH", "code_information": [{"code": "D9971", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFATUMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9302", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFF ASSIS EOL ISS", "code_information": [{"code": "G9380", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX 70MIN", "code_information": [{"code": "G2086", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, 60 M", "code_information": [{"code": "G2087", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, ADD30", "code_information": [{"code": "G2088", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST LOW 30", "code_information": [{"code": "99243", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST MOD 40", "code_information": [{"code": "99244", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFF/OP CONSLTJ NEW/EST HI 55", "code_information": [{"code": "99245", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFF/OP CONSLTJ NEW/EST SF 20", "code_information": [{"code": "99242", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFFICE EMERGENCY CARE", "code_information": [{"code": "99058", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST HI 40 MIN", "code_information": [{"code": "99215", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P EST MOD 30 MIN", "code_information": [{"code": "99214", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW HI 60 MIN", "code_information": [{"code": "99205", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFFICE O/P NEW MOD 45 MIN", "code_information": [{"code": "99204", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFFICE VISIT AFTER HOURS", "code_information": [{"code": "D9440", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OFFICE VISIT DURING HOURS", "code_information": [{"code": "D9430", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 11-20 MIN", "code_information": [{"code": "99422", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 21+ MIN", "code_information": [{"code": "99423", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OL DIG E/M SVC 5-10 MIN", "code_information": [{"code": "99421", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OLANZAPINE LONG-ACTING INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OLIGOCLONAL BANDS", "code_information": [{"code": "83916", "type": "CPT"}], "standard_charges": [{"minimum": 31.5, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OMALIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2357", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OMENTAL FLAP EXTRA-ABDOM", "code_information": [{"code": "49904", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OMENTAL FLAP INTRA-ABDOM", "code_information": [{"code": "49905", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OMEZA COLLAG PER 100 MG", "code_information": [{"code": "A2014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OMNICARDIOGRAM/CARDIOINTEGRA", "code_information": [{"code": "S9025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OMNICEF (CEFDINIR) CAP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000349", "type": "CDM"}, {"code": "65862017760", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ONC AML DNA DETCJ/NONDETCJ", "code_information": [{"code": "23U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC B CLL LYMPHM MRNA 58 GEN", "code_information": [{"code": "120U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BLADDER MRNA 219 GEN ALG", "code_information": [{"code": "16M", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 FLWG TRURL RESCJ", "code_information": [{"code": "367U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 PRB BLDR CA", "code_information": [{"code": "365U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 PRB RECR BLDR CA", "code_information": [{"code": "366U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 101 GENES", "code_information": [{"code": "153U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 12 GENES", "code_information": [{"code": "81522", "type": "CPT"}], "standard_charges": [{"minimum": 4453.95, "maximum": 4453.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4453.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 58 GENES", "code_information": [{"code": "81520", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 2886.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2886.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 70 GENES", "code_information": [{"code": "81521", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 4453.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4453.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRN SPHRD CLL 12 RX PNL", "code_information": [{"code": "248U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST ALYS 32 PHSPRTN ALG", "code_information": [{"code": "249U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA AI ASSMT 12 FEAT", "code_information": [{"code": "220U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA DNA PIK3CA 11", "code_information": [{"code": "177U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA DNA PIK3CA GENE", "code_information": [{"code": "155U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA ERBB2 AMP/NONAMP", "code_information": [{"code": "9U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST DUX CARC 7 PROTEINS", "code_information": [{"code": "295U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST DUX CARC IS 12 GENE", "code_information": [{"code": "45U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST IMHCHEM PRFL 4 BMRK", "code_information": [{"code": "67U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST MRNA 11 GENES", "code_information": [{"code": "81518", "type": "CPT"}], "standard_charges": [{"minimum": 4453.95, "maximum": 4453.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4453.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST MRNA 70 CNT 31 GENE", "code_information": [{"code": "81523", "type": "CPT"}], "standard_charges": [{"minimum": 4453.95, "maximum": 4453.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4453.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST SEMIQ MEAS THYM KN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1429", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC BRST SEMIQ MEAS THYM KN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2404", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CHEMO RX CYTOX CSC 14 RX", "code_information": [{"code": "435U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT 3 UR METAB ALG PLP", "code_information": [{"code": "2U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT CA IMG ALYS W/AI", "code_information": [{"code": "261U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT CA MUT&MTHYLTN MRK", "code_information": [{"code": "368U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT MICRORNA MIR-31-3P", "code_information": [{"code": "69U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR 3 PRTN ALG", "code_information": [{"code": "163U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR SGL AMP 8 RNA", "code_information": [{"code": "421U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR WHL BLD ALG", "code_information": [{"code": "91U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC COLON CA KRAS&NRAS ALYS", "code_information": [{"code": "111U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN MLNMA MRNA 23 GENE", "code_information": [{"code": "90U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN MLNMA MRNA 31 GENE", "code_information": [{"code": "81529", "type": "CPT"}], "standard_charges": [{"minimum": 8271.95, "maximum": 8271.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8271.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN MLNMA MRNA 35 GENE", "code_information": [{"code": "314U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN SQ CLL CA MRNA 40", "code_information": [{"code": "315U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DLBCL MRNA 20 GENES ALG", "code_information": [{"code": "17M", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST METASTIC/ RECUR", "code_information": [{"code": "G9075", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG1-2 NOPROGRES", "code_information": [{"code": "G9072", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG1-2B HR,NOPRO", "code_information": [{"code": "G9071", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG3-HR, NO PRO", "code_information": [{"code": "G9073", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG3-NOPROGRESS", "code_information": [{"code": "G9074", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST UNKNOWN NOS", "code_information": [{"code": "G9131", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML ACCELER PHASE", "code_information": [{"code": "G9124", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML BLAST PHASE", "code_information": [{"code": "G9125", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML CHRONIC PHASE", "code_information": [{"code": "G9123", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML DX STATUS UNKNOWN", "code_information": [{"code": "G9139", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML REMISSION", "code_information": [{"code": "G9126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON EXTENT UNKNOWN", "code_information": [{"code": "G9089", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON METAS EVID DX", "code_information": [{"code": "G9087", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON METAS NOEVID DX", "code_information": [{"code": "G9088", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T1-3,N1-2,NO PR", "code_information": [{"code": "G9084", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T1-4 NO DX PROG", "code_information": [{"code": "G9086", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T4, N0 W/O PROG", "code_information": [{"code": "G9085", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAG T1-T3 NOPROG", "code_information": [{"code": "G9096", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL METS RECUR", "code_information": [{"code": "G9098", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL T4 NO PROG", "code_information": [{"code": "G9097", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL UNKNOWN", "code_information": [{"code": "G9099", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC NO RECURRENCE", "code_information": [{"code": "G9100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC P R1-R2NOPROG", "code_information": [{"code": "G9101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC RECURRENT", "code_information": [{"code": "G9103", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC UNKNOWN NOS", "code_information": [{"code": "G9104", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC UNRESECTABLE", "code_information": [{"code": "G9102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK EXT UNKNOWN", "code_information": [{"code": "G9112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK M1 METS REC", "code_information": [{"code": "G9111", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK T1-T2NO PRG", "code_information": [{"code": "G9109", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK T3-4 NOPROG", "code_information": [{"code": "G9110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULT MYELOMA STG2 HIG", "code_information": [{"code": "G9129", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULTI MYELOMA STAGE I", "code_information": [{"code": "G9128", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULTI MYELOMA UNKNOWN", "code_information": [{"code": "G9130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL RELAPSE/REFRACTOR", "code_information": [{"code": "G9137", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL STG 3-4 NOT RELAP", "code_information": [{"code": "G9135", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL STG UNKNOWN", "code_information": [{"code": "G9138", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL TRANS TO LG BCELL", "code_information": [{"code": "G9136", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC DX UNKNOWN NOS", "code_information": [{"code": "G9067", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG2 NO PROGRES", "code_information": [{"code": "G9064", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG3A NO PROGRE", "code_information": [{"code": "G9065", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG3B-4 METASTA", "code_information": [{"code": "G9066", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STGI NO PROGRES", "code_information": [{"code": "G9063", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN RECURRENCE", "code_information": [{"code": "G9116", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG1A-B NO PR", "code_information": [{"code": "G9113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG1A-B OR 2", "code_information": [{"code": "G9114", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG3/4 NOPROG", "code_information": [{"code": "G9115", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN UNKNOWN NOS", "code_information": [{"code": "G9117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATC P R0 RES NO", "code_information": [{"code": "G9105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATC P R1/R2 NO", "code_information": [{"code": "G9106", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATIC UNKNWN NOS", "code_information": [{"code": "G9108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATIC UNRESECTAB", "code_information": [{"code": "G9107", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE CLINICAL MET", "code_information": [{"code": "G9133", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE METS NO CAST", "code_information": [{"code": "G9132", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T1NO PROGRES", "code_information": [{"code": "G9077", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T2NO PROGRES", "code_information": [{"code": "G9078", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T3B-T4NOPROG", "code_information": [{"code": "G9079", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE UNKNWN NOS", "code_information": [{"code": "G9083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE W/RISE PSA", "code_information": [{"code": "G9080", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL EXTENT UNKNWN", "code_information": [{"code": "G9095", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL M1 W/METS PROG", "code_information": [{"code": "G9094", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T1-2 NO PROGR", "code_information": [{"code": "G9090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T1-3,N1-2NOPRG", "code_information": [{"code": "G9092", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T3 N0 NO PROG", "code_information": [{"code": "G9091", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T4,N,M0 NO PRG", "code_information": [{"code": "G9093", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC EXT AT DX", "code_information": [{"code": "G9069", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC EXT UNKNWN", "code_information": [{"code": "G9070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC LIMITED", "code_information": [{"code": "G9068", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC EXPECTANT MANAGEMENT PT", "code_information": [{"code": "G9053", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC GASTRO 51 GENE NOMOGRAM", "code_information": [{"code": "7M", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC HEP GENE RISK CLASSIFIER", "code_information": [{"code": "6M", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC HL NEO GEN SEQ ALYS ALG", "code_information": [{"code": "364U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC HL NEO OPT GEN MAPPING", "code_information": [{"code": "331U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC HMTLMF NEO JAK2 MUT DNA", "code_information": [{"code": "17U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC HMTLMF NEO RNA BCR/ABL1", "code_information": [{"code": "16U", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LNCH SYN GEN DNA SEQ ALY", "code_information": [{"code": "238U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LNG 3 PRTN BMRK PLSM ALG", "code_information": [{"code": "92U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LNG 5 CLIN RSK FACTR ALG", "code_information": [{"code": "80U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LNG MULTIOMICS PLSM ALG", "code_information": [{"code": "401U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LNG MULTIOMICS PLSM ALG", "code_information": [{"code": "403U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LNG PLSM ALYS 388 PRTN", "code_information": [{"code": "436U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LUNG CA 4-PRB FISH ASSAY", "code_information": [{"code": "317U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LUNG ELISA 7 AUTOANT ALG", "code_information": [{"code": "360U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LUNG MRNA QUAN PCR 11&3", "code_information": [{"code": "288U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LVR SURVEILANC HCC CFDNA", "code_information": [{"code": "333U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC MERKEL CLL CARC SRM +/-", "code_information": [{"code": "59U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC MERKEL CLL CARC SRM QUAN", "code_information": [{"code": "58U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC MLNMA AMBRA1&AMLO", "code_information": [{"code": "387U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC MLNMA PRAME & LINC00518", "code_information": [{"code": "89U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC MRD NXT-GNRJ ALYS 1ST", "code_information": [{"code": "306U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC MRD NXT-GNRJ ALYS SBSQ", "code_information": [{"code": "307U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC MRNA 5 GEN RECR URTHL CA", "code_information": [{"code": "13M", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC MRNA 5 GEN RSK URTHL CA", "code_information": [{"code": "12M", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC NEO XOME&TRNS SEQ ALYS", "code_information": [{"code": "329U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC NHLSTG 1-2 NO RELAP NO", "code_information": [{"code": "G9134", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC NONSM CLL LNG CA 37 GEN", "code_information": [{"code": "388U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC NONSM CLL LNG CA ALYS 23", "code_information": [{"code": "179U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC ORL&/OROP CA 20 MLC FEAT", "code_information": [{"code": "296U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC OROP/ANAL 17 DNA DDPCR", "code_information": [{"code": "356U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC OVAR 5 PRTN SER ALG SCOR", "code_information": [{"code": "3U", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC OVRN BCHM ASY 7 PRTN ALG", "code_information": [{"code": "375U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAN CA ALYS MRD PLASMA", "code_information": [{"code": "340U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAN SOLID TUM ALYS DNA", "code_information": [{"code": "422U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM GEN PRFLG 8 DNA", "code_information": [{"code": "332U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN OPT MAPG", "code_information": [{"code": "299U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN SEQ DNA", "code_information": [{"code": "297U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN SEQ&OPT", "code_information": [{"code": "300U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL TRNS SEQ RNA", "code_information": [{"code": "298U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAN-TUM DNA&RNA GNRJ SEQ", "code_information": [{"code": "211U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PAP THYR CA RNA 82&10", "code_information": [{"code": "362U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PLSM CELL DO&MYELOMA ID", "code_information": [{"code": "337U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PNCRS DNA&MRNA SEQ 74", "code_information": [{"code": "313U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PNCRTC 59 MTHLTN BLK MRK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PNCRTC CA MULT IA ECLIA", "code_information": [{"code": "342U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC COND NOADD BY GUIDE", "code_information": [{"code": "G9061", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC GUIDE DIFFERS NOS", "code_information": [{"code": "G9062", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT ADHERES GUIDE", "code_information": [{"code": "G9056", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT DIF PT COMORB", "code_information": [{"code": "G9060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT DISAGREE W/GUI", "code_information": [{"code": "G9058", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT PT OPT ALTERNA", "code_information": [{"code": "G9059", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRACT MGMT DIFFERS TRIAL", "code_information": [{"code": "G9057", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE 3 GENES", "code_information": [{"code": "81551", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 2334.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2334.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE MRNA 22 CNT GEN", "code_information": [{"code": "81542", "type": "CPT"}], "standard_charges": [{"minimum": 4453.95, "maximum": 4453.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4453.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE MRNA 46 GENES", "code_information": [{"code": "81541", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 4453.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4453.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 5 DNA REG MRK PCR", "code_information": [{"code": "433U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA ALYS ALL PSA", "code_information": [{"code": "359U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA IMG ALYS 128", "code_information": [{"code": "376U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA MRNA 12 GEN ALG", "code_information": [{"code": "11M", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 DETCJ 8 AUTOANTB", "code_information": [{"code": "21U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MA MOLEC PRFL ALG", "code_information": [{"code": "228U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA 17 GENE ALG", "code_information": [{"code": "47U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA 18 GEN DRE UR", "code_information": [{"code": "G0018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA 18 GEN DRE UR", "code_information": [{"code": "G0465", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA HOXC6 & DLX1", "code_information": [{"code": "339U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 PCA3&TMPRSS2-ERG", "code_information": [{"code": "113U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 XOM ALY 442 SNCRNA", "code_information": [{"code": "343U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 XOM ALYS 53 SNCRNA", "code_information": [{"code": "424U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC RNA TISS PREDICT ALG", "code_information": [{"code": "19U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC RSPS RADJ CLL FR DNA TOX", "code_information": [{"code": "285U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC RSPSE CHEMO CNTRST TOMOG", "code_information": [{"code": "83U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORG NEO DNA 468 GENE", "code_information": [{"code": "48U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORG NEO DNA 505 GENE", "code_information": [{"code": "250U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORGN TGSA DNA 84/+", "code_information": [{"code": "334U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM ALYS BRCA1 BRCA2", "code_information": [{"code": "172U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM CRCG TUM CL SLCT", "code_information": [{"code": "338U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM DNA&RNA 437 GEN", "code_information": [{"code": "391U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM RT-PCR 7 GEN", "code_information": [{"code": "262U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SOLID ORGN DNA 257 GENES", "code_information": [{"code": "244U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SOLID TUMOR 30 PRTN TRGT", "code_information": [{"code": "174U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SUPERVISION PALLIATIVE", "code_information": [{"code": "G9054", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SURVEILLANCE FOR DISEASE", "code_information": [{"code": "G9052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC THYR 10 MICRORNA SEQ ALG", "code_information": [{"code": "18U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC THYR DNA&MRNA 112 GENES", "code_information": [{"code": "26U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC THYR DNA&MRNA 112 GENES", "code_information": [{"code": "287U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC THYR MRNA 10,196 GEN ALG", "code_information": [{"code": "81546", "type": "CPT"}], "standard_charges": [{"minimum": 4140.0, "maximum": 4140.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4140.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC THYR MUT ALYS 10 GEN&37", "code_information": [{"code": "245U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC URTHL CA RNA FGFR3 GENE", "code_information": [{"code": "154U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC URTHL MRNA 5 GEN ALG", "code_information": [{"code": "363U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC URTHL MRNA XPRSN 6 SNP", "code_information": [{"code": "420U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC UVEAL MLNMA MRNA 15 GENE", "code_information": [{"code": "81552", "type": "CPT"}], "standard_charges": [{"minimum": 8942.4, "maximum": 8942.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8942.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC VISIT UNSPECIFIED NOS", "code_information": [{"code": "G9055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCO (OVAR) FIVE PROTEINS", "code_information": [{"code": "81503", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 1031.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1031.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCO (OVAR) TWO PROTEINS", "code_information": [{"code": "81500", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 299.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 299.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCO PRST8 3 GENE UR ALG", "code_information": [{"code": "5U", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY BREAST MRNA", "code_information": [{"code": "81519", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 4453.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4453.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY COLON MRNA", "code_information": [{"code": "81525", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 3583.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3583.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY COLORECTAL SCR", "code_information": [{"code": "81528", "type": "CPT"}], "standard_charges": [{"minimum": 585.2, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 585.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY GYNECOLOGIC", "code_information": [{"code": "81535", "type": "CPT"}], "standard_charges": [{"minimum": 666.38, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 666.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY GYNECOLOGIC", "code_information": [{"code": "81536", "type": "CPT"}], "standard_charges": [{"minimum": 204.19, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 204.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY LUNG", "code_information": [{"code": "81538", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 3301.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3301.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY PROSTATE PROB SCORE", "code_information": [{"code": "81539", "type": "CPT"}], "standard_charges": [{"minimum": 874.0, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 874.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY TISSUE OF ORIGIN", "code_information": [{"code": "81504", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 598.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 598.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY TUM UNKNOWN ORIGIN", "code_information": [{"code": "81540", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 4312.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4312.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY TX DECISION-MGMT", "code_information": [{"code": "G9051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY WORK-UP EVALUATION", "code_information": [{"code": "G9050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY/HEMA SS", "code_information": [{"code": "G4019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOPROTEIN DCP", "code_information": [{"code": "83951", "type": "CPT"}], "standard_charges": [{"minimum": 74.07, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONCOPROTEIN HER-2/NEU", "code_information": [{"code": "83950", "type": "CPT"}], "standard_charges": [{"minimum": 74.07, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON 4 MG", "code_information": [{"code": "S0119", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2405", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "estimated_discounted_cash": 17.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 7.75, "count": "1 through 10", "median_amount": 8.55, "methodology": "percent of total billed charges", "10th_percentile": 6.15, "90th_percentile": 8.55}], "billing_class": "facility"}]}, {"description": "ONE A DAY ENERGY VITAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001144", "type": "CDM"}, {"code": "16500058697", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ONE-WAY ALLOW PRORATED MILES", "code_information": [{"code": "P9603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONE-WAY ALLOW PRORATED TRIP", "code_information": [{"code": "P9604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONGOING CARE NOT IND", "code_information": [{"code": "M1146", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY CST BASE MTL 2 SURFACE", "code_information": [{"code": "D6612", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY CST BASE MTL >=3 SURFA", "code_information": [{"code": "D6613", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY CST HGH NBL MTL 2 SRFC", "code_information": [{"code": "D6610", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY CST HGH NBL MTL >=3SRF", "code_information": [{"code": "D6611", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY CST NBL MTL 2 SURFACES", "code_information": [{"code": "D6614", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY CST NBL MTL >=3 SURFAC", "code_information": [{"code": "D6615", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY PORC/CRMC 2 SURFACES", "code_information": [{"code": "D6608", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY PORC/CRMC >=3 SURFACES", "code_information": [{"code": "D6609", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY REPAIR", "code_information": [{"code": "D2982", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONLAY TITANIUM", "code_information": [{"code": "D6634", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OOCYTE IDENTIFICATION", "code_information": [{"code": "89254", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 401.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OP REPR SUPRWND 2.5CM-LSS SIM FACE(TECH)", "code_information": [{"code": "12011", "type": "CPT"}, {"code": "11000298", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "estimated_discounted_cash": 506.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR CRYO", "code_information": [{"code": "47381", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR RF", "code_information": [{"code": "47380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN AORTIC TUBE PROSTH REPR", "code_information": [{"code": "34830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOFEMOR PROSTH REPR", "code_information": [{"code": "34832", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOILIAC PROSTH REPR", "code_information": [{"code": "34831", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN BIOPSY OF LUNG PLEURA", "code_information": [{"code": "32098", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN BOWEL TO SKIN", "code_information": [{"code": "44300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN BX/EXC INGUINOFEM NODES", "code_information": [{"code": "38531", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN CHEST HEART MASSAGE", "code_information": [{"code": "32160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN CORONARY ENDARTERECTOMY", "code_information": [{"code": "33572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN DRAINAGE LIVER LESION", "code_information": [{"code": "47010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN EXC CERV NODE(S) W/ ID", "code_information": [{"code": "C7503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "35600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN ISLET CELL TRANSPLANT", "code_information": [{"code": "586T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/ FIXJ", "code_information": [{"code": "21339", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/O FIXJ", "code_information": [{"code": "21338", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN RED COMP MALAR/ZYGMA FX", "code_information": [{"code": "D7750", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN RED SIMP MALAR/ZYGOM FX", "code_information": [{"code": "D7650", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN RED SIMPL MANDIBLE FX", "code_information": [{"code": "D7630", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN REDUC COMPD ALVEOLUS FX", "code_information": [{"code": "D7770", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCT COMPD MANDBLE FX", "code_information": [{"code": "D7730", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61312", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61313", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61314", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61315", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61321", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61304", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN THROMBECT AV FISTULA", "code_information": [{"code": "36831", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX COMPL FRONT SINUS FX", "code_information": [{"code": "21344", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX DPRSD FRONT SINUS FX", "code_information": [{"code": "21343", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX ILIAC SPINE UNI/BIL", "code_information": [{"code": "G0412", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE & SEPTAL FX", "code_information": [{"code": "21335", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX UNCOMPLICATD", "code_information": [{"code": "21325", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX W/SKELE FIXJ", "code_information": [{"code": "21330", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX POST PELVIC FXCTURE", "code_information": [{"code": "G0415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX SEPTAL FX W/WO STABJ", "code_information": [{"code": "21336", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG INFILTR", "code_information": [{"code": "32096", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG NODULE", "code_information": [{"code": "32097", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT 1ST", "code_information": [{"code": "37236", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37237", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37239", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT SAME", "code_information": [{"code": "37238", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPH AMD ALYS 3 GENE VARIANTS", "code_information": [{"code": "205U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPH US DX ANT SGM US UNI/BI", "code_information": [{"code": "76513", "type": "CPT"}], "standard_charges": [{"minimum": 96.1, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 96.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN", "code_information": [{"code": "76512", "type": "CPT"}], "standard_charges": [{"minimum": 61.46, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN&QUAN A-SCAN", "code_information": [{"code": "76510", "type": "CPT"}], "standard_charges": [{"minimum": 88.74, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 88.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPH US DX QUAN A-SCAN ONLY", "code_information": [{"code": "76511", "type": "CPT"}], "standard_charges": [{"minimum": 72.66, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 72.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC BIOMETRY", "code_information": [{"code": "92136", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC ENDOSCOPE ADD-ON", "code_information": [{"code": "66990", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC MITOMYCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7315", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPHTHALMODYNAMOMETRY", "code_information": [{"code": "92260", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPHTHALMOLOGY/OPTOMETRY SS", "code_information": [{"code": "G4020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPIATES 1 OR MORE", "code_information": [{"code": "80361", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPIOID &OPIATE ANALOG 5/MORE", "code_information": [{"code": "80364", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 1/2", "code_information": [{"code": "80362", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 3/4", "code_information": [{"code": "80363", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS", "code_information": [{"code": "34715", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS CNDT", "code_information": [{"code": "34716", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN BRACH ART EXPOS", "code_information": [{"code": "34834", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS", "code_information": [{"code": "34812", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS CNDT CRTJ", "code_information": [{"code": "34714", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN ILAC ART EXPOS CNDT CRTJ", "code_information": [{"code": "34833", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN ILIAC ART EXPOS", "code_information": [{"code": "34820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ CRNL NRV NEA&PG", "code_information": [{"code": "64568", "type": "CPT"}], "standard_charges": [{"minimum": 65922.57, "maximum": 65922.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 65922.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA NEUROMUSCULAR", "code_information": [{"code": "64580", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA PERPH NERVE", "code_information": [{"code": "64575", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA SACRAL NERVE", "code_information": [{"code": "64581", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBF", "code_information": [{"code": "817T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBQ", "code_information": [{"code": "816T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN MPLTJ HPGLSL NSTM ARY PG", "code_information": [{"code": "64582", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR FX", "code_information": [{"code": "21365", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR W/GRFT", "code_information": [{"code": "21366", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD MALAR FRACTURE", "code_information": [{"code": "21360", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD ZYGOMATIC ARCH", "code_information": [{"code": "21356", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX MULTPLE", "code_information": [{"code": "21347", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/FIXJ", "code_information": [{"code": "21346", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/GRAFT", "code_information": [{"code": "21348", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX COMBINED", "code_information": [{"code": "21387", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX PERIORBITAL", "code_information": [{"code": "21386", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX TRANSANTRAL", "code_information": [{"code": "21385", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/BONE GRFT", "code_information": [{"code": "21408", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/IMPLANT", "code_information": [{"code": "21407", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/O IMPLANT", "code_information": [{"code": "21406", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBT W/GRFT", "code_information": [{"code": "21395", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBTL IMPLT", "code_information": [{"code": "21390", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPPS SERVICE,SCHED TEAM CONF", "code_information": [{"code": "G0175", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPPS/PHP/IOP; ACTIVITY THRPY", "code_information": [{"code": "G0176", "type": "HCPCS"}], "standard_charges": [{"minimum": 550.81, "maximum": 550.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 550.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPPS/PHP/IOP; TRAIN & EDUC", "code_information": [{"code": "G0177", "type": "HCPCS"}], "standard_charges": [{"minimum": 550.81, "maximum": 550.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 550.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPRELVEKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2355", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND ON/MAC DRAW", "code_information": [{"code": "92202", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND RTA DRAW UNI/BI", "code_information": [{"code": "92201", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPT CARE KIDNEY HLTH MVP", "code_information": [{"code": "M0002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTIC NERVE HEAD EVAL DONE", "code_information": [{"code": "2027F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTICAL ENDOMICROSCPY INTERP", "code_information": [{"code": "88375", "type": "CPT"}], "standard_charges": [{"minimum": 53.6, "maximum": 53.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTICHAMBER ADVANTAGE", "code_information": [{"code": "3001297", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.61, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OPTO-ACOUSTIC IMG BREAST UNI", "code_information": [{"code": "857T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92534", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92544", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX ACRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23552", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX ACROMCLV DISLC AQT/CHRN", "code_information": [{"code": "23550", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX ACUTE SHOULDER DISLC", "code_information": [{"code": "23660", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX CLAVICULAR FX W/INT FIX", "code_information": [{"code": "23515", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX GR HMRL TBRS FX INT FIX", "code_information": [{"code": "23630", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX MEDIAL ANKLE FX", "code_information": [{"code": "27766", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX OF RIB FX W/FIXJ SCOPE", "code_information": [{"code": "21811", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX POST ANKLE FX", "code_information": [{"code": "27769", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX PROX HUMRL FX W/INT FIX", "code_information": [{"code": "23615", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX PRX HMRL FX FIX RPR RPL", "code_information": [{"code": "23616", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX SCAPULAR FX W/INT FIXJ", "code_information": [{"code": "23585", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC FX", "code_information": [{"code": "23670", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC NECK FX FIXJ", "code_information": [{"code": "23680", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX STRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23532", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX STRNCLAV DISLC AQT/CHRN", "code_information": [{"code": "23530", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTX THIGH FX", "code_information": [{"code": "27269", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL ANTIPLAT THX RX DISCHRG", "code_information": [{"code": "4073F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL ANTIPLATELET THERAPY RX", "code_information": [{"code": "4011F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL ANTRAL FISTULA CLOSURE", "code_information": [{"code": "D7260", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL APP THXPY TITRATION VIS", "code_information": [{"code": "D9955", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL APREPITANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8501", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL BUSULFAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL DEV WITHOUT FIX MECH", "code_information": [{"code": "K1027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL DV/APP NEUROMUS MOUTHPI", "code_information": [{"code": "E0493", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL EVALUATION, PT < 3YRS", "code_information": [{"code": "D0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL EVEROLIMUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7527", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL FLUDARABINE PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8562", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL FUNCTION THERAPY", "code_information": [{"code": "92526", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "estimated_discounted_cash": 244.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0435", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL HYGIENE INSTRUCTION", "code_information": [{"code": "D1330", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL MED ADM DIRECT OBSERVE", "code_information": [{"code": "H0033", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.09, "maximum": 109.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 109.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL MR CONTRAST, 100 ML", "code_information": [{"code": "Q9954", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL MUCOADHESIVE PER 1 ML", "code_information": [{"code": "A9156", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL NETUPITANT, PALONOSETRO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8655", "type": "HCPCS"}], "standard_charges": [{"minimum": 2239.49, "maximum": 2239.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2239.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL PRESCRIP DRUG NON CHEMO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL PRESCRIPTION DRUG CHEMO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL SPEECH DEVICE EVAL", "code_information": [{"code": "92597", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL SUCTION (DISP)", "code_information": [{"code": "3000256", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ORAL SURGERY PROCEDURE", "code_information": [{"code": "D7999", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL/FACIAL PHOTO IMAGES", "code_information": [{"code": "D0350", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAMORPH SR (MORPHIN SULF ER) TAB 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000180", "type": "CDM"}, {"code": "54868498100", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ORAPRED (PREDNISOLONE) SYRUP 15MG/5ML", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J7510", "type": "HCPCS"}, {"code": "7200085", "type": "CDM"}, {"code": "00121075908", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.11, "maximum": 19.12, "gross_charge": 21.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "113", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "114", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROSTHESIS", "code_information": [{"code": "D5915", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORBITAL REPLACEMENT", "code_information": [{"code": "D5928", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61584", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61585", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61592", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY PARTIAL", "code_information": [{"code": "54522", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY (FOWLER-STEPHENS)", "code_information": [{"code": "54650", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY INGUN/SCROT APPR", "code_information": [{"code": "54640", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS QUAL EACH", "code_information": [{"code": "83919", "type": "CPT"}], "standard_charges": [{"minimum": 18.92, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS TOTAL QUANT", "code_information": [{"code": "83918", "type": "CPT"}], "standard_charges": [{"minimum": 27.14, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [{"code": "884", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "estimated_discounted_cash": 4637.88, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ORION, PER SQ CM", "code_information": [{"code": "Q4276", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORPHENADRINE (30MG/ML) 60MG/2ML INJ.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2360", "type": "HCPCS"}, {"code": "72004305", "type": "CDM"}, {"code": "50090243800", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 20.63, "maximum": 32.58, "gross_charge": 36.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 32.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTH DEV REPAIR/REPL MINOR P", "code_information": [{"code": "L4210", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTH FOOT ADD CHARGE SPLIT S", "code_information": [{"code": "L3257", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTH FOOT NON-STANDARD SIZE/", "code_information": [{"code": "L3255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTH FOOT NON-STNDARD SIZE/W", "code_information": [{"code": "L3254", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTH/DEVIC/DRUG BN/BN,TIS/BN", "code_information": [{"code": "C1734", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTH/MATRX/BN FILL DRUG-ELUT", "code_information": [{"code": "C1602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHC/PROSTC MGMT SBSQ ENC", "code_information": [{"code": "97763", "type": "CPT"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHO DVC REPAIR PER 15 MIN", "code_information": [{"code": "L4205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHODONTIC PROCEDURE", "code_information": [{"code": "D8999", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHODONTIC REM APPLIANCE TX", "code_information": [{"code": "D8210", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHODONTIC RETENTION", "code_information": [{"code": "D8680", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOP TRAING PFRMD PHYS/QHP", "code_information": [{"code": "92065", "type": "CPT"}], "standard_charges": [{"minimum": 510.0, "maximum": 510.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOP TRAING SUPVJ PHYS/QHP", "code_information": [{"code": "92066", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOPED LADIES SHOES DPTH I", "code_information": [{"code": "L3216", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOPEDIC FTWEAR LADIES OXF", "code_information": [{"code": "L3215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOPEDIC MENS SHOES DPTH I", "code_information": [{"code": "L3221", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOPEDIC MENS SHOES OXFORD", "code_information": [{"code": "L3219", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOPEDIC SHOE MODIFICA NOS", "code_information": [{"code": "L3649", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOPEDIC SURGERY SS", "code_information": [{"code": "G4021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOPOXVIRUS AMP PRB EACH", "code_information": [{"code": "87593", "type": "CPT"}], "standard_charges": [{"minimum": 51.31, "maximum": 51.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOTIC MGMT&TRAING 1ST ENC", "code_information": [{"code": "97760", "type": "CPT"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOVISC INJ PER DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7324", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OS-CAL (CALCIUM + D) TAB 500MG/200IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000746", "type": "CDM"}, {"code": "00088165475", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OSCILLATING TRACKING TEST", "code_information": [{"code": "92545", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSMITROL (MANNITOL) 25% INJ 12.5GM/50ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2150", "type": "HCPCS"}, {"code": "7000302", "type": "CDM"}, {"code": "63323002425", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY 24HR UR", "code_information": [{"code": "83935", "type": "CPT"}, {"code": "1000341", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.84, "maximum": 36.31, "gross_charge": 40.35, "discounted_cash": 54.17, "estimated_discounted_cash": 53.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY URINE", "code_information": [{"code": "83935", "type": "CPT"}, {"code": "1000457", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.84, "maximum": 47.7, "gross_charge": 53.0, "discounted_cash": 54.17, "estimated_discounted_cash": 53.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSSEOUS SURG 1 TO 3 TEETH", "code_information": [{"code": "D4261", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSSEOUS SURGERY 4 OR MORE", "code_information": [{"code": "D4260", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEO BI FLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000805", "type": "CDM"}, {"code": "30768003136", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OSTEOART ALGRFT W/SURF & B1", "code_information": [{"code": "20932", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOARTHRITIS ASSESS", "code_information": [{"code": "1006F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOARTHRITIS COMPOSITE", "code_information": [{"code": "5F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE ALLOGRAFT", "code_information": [{"code": "27415", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE AUTOGRAFT", "code_information": [{"code": "27416", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL TALUS AUTOGRFT", "code_information": [{"code": "28446", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH CC", "code_information": [{"code": "540", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH MCC", "code_information": [{"code": "539", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITHOUT CC/MCC", "code_information": [{"code": "541", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 1-2 REGIONS", "code_information": [{"code": "98925", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 3-4 REGIONS", "code_information": [{"code": "98926", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 5-6 REGIONS", "code_information": [{"code": "98927", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 7-8 REGIONS", "code_information": [{"code": "98928", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 9-10 REGIONS", "code_information": [{"code": "98929", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1 VRT SGM CRV", "code_information": [{"code": "22220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM EA", "code_information": [{"code": "22226", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM LMBR", "code_information": [{"code": "22224", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM THRC", "code_information": [{"code": "22222", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT HUM XTRNL LNGTH DEV", "code_information": [{"code": "594T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTOMY SUPPLY MISC", "code_information": [{"code": "A4421", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OT APPLY FOREARM SPLINT", "code_information": [{"code": "4400001", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 315.12, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT APPLY LONG ARM SPLINT", "code_information": [{"code": "4400002", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 406.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT COMMUNITY WORK RE INTEG", "code_information": [{"code": "4400004", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 94.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT E-STIM CONSTANT ATTEND", "code_information": [{"code": "4400005", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 52.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT E-STIM UNATTENDED NOT WOUNDS", "code_information": [{"code": "4400006", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 41.67, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT EVAL HIGH COMPLEX 60 MIN", "code_information": [{"code": "97167", "type": "CPT"}], "standard_charges": [{"minimum": 95.67, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OT EVAL HIGH COMPLEXITY", "code_information": [{"code": "4400143", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 236.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT EVAL LOW COMPLEXITY", "code_information": [{"code": "4400026", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 256.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT EVAL MOD COMPLEX 45 MIN", "code_information": [{"code": "97166", "type": "CPT"}], "standard_charges": [{"minimum": 95.67, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OT EVAL MODERATE COMPLEXITY", "code_information": [{"code": "4400142", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 236.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT GROUP THERAPY", "code_information": [{"code": "4400007", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 52.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT IONTOPHORESIS", "code_information": [{"code": "4400028", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 89.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT MANUAL THERAPY", "code_information": [{"code": "4400010", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 83.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT MASSAGE THERAPY", "code_information": [{"code": "4400011", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 86.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT NEUROMUSCULAR RE-ED", "code_information": [{"code": "4400012", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 99.09, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT ORTHOTIC FITTING & TRAINING", "code_information": [{"code": "4400013", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 131.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT PARAFFIN BATH SUPERVISED", "code_information": [{"code": "4400015", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 29.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT PHYSICAL PERF TEST/MEASUREMENT", "code_information": [{"code": "4400016", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 106.32, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT PROSTHETIC TRAINING", "code_information": [{"code": "4400017", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 114.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT RE EVAL", "code_information": [{"code": "4400027", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 174.12, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT RE-EVAL EST PLAN CARE", "code_information": [{"code": "97168", "type": "CPT"}], "standard_charges": [{"minimum": 65.43, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 65.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OT SELF CARE MANAGEMENT", "code_information": [{"code": "4400018", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 97.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT SENSORY INTEGRATIVE TECH", "code_information": [{"code": "4400019", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 96.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT TELEHEALTH EVAL", "code_information": [{"code": "97165", "type": "CPT"}, {"code": "4400157", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 95.67, "maximum": 589.34, "gross_charge": 379.08, "discounted_cash": 54.17, "estimated_discounted_cash": 256.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 303.26, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 341.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 216.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT THERAPEUTIC ACTIVITY", "code_information": [{"code": "4400020", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 113.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT THERAPEUTIC EXERCISE", "code_information": [{"code": "4400021", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 89.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT ULTRASOUND CONSTANT ATTEND", "code_information": [{"code": "4400022", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 38.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT VASOPNEUMATIC DEVICE", "code_information": [{"code": "4400023", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 53.82, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT W/C MANAGEMENT TRAINING", "code_information": [{"code": "4400024", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 95.07, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OT WHIRLPOOL SUPERVISED", "code_information": [{"code": "4400025", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 64.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OTH RESP PROC, GROUP", "code_information": [{"code": "G0239", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTH RESP PROC, INDIV", "code_information": [{"code": "G0238", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHE THERAPIST AT HOSPICE", "code_information": [{"code": "G9478", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "818", "type": "MS-DRG"}], "standard_charges": [{"minimum": 245.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 245.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "817", "type": "MS-DRG"}], "standard_charges": [{"minimum": 245.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 245.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "819", "type": "MS-DRG"}], "standard_charges": [{"minimum": 245.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 245.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [{"code": "832", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC", "code_information": [{"code": "831", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "833", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER BONE GRAFT MICROVASC", "code_information": [{"code": "20962", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [{"code": "228", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [{"code": "229", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER CAROT STEN 120 DAYS/>", "code_information": [{"code": "9007F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "315", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 4597.43, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "314", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "316", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [{"code": "264", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER COUNSELOR AT HOSPICE", "code_information": [{"code": "G9475", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "394", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "393", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "395", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC", "code_information": [{"code": "357", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [{"code": "356", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "358", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "92", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "91", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "93", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [{"code": "124", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [{"code": "125", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [{"code": "155", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [{"code": "154", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "156", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [{"code": "144", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC", "code_information": [{"code": "143", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "145", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [{"code": "629", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [{"code": "628", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "630", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [{"code": "319", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [{"code": "320", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [{"code": "951", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC", "code_information": [{"code": "749", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "750", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [{"code": "215", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [{"code": "424", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [{"code": "423", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "425", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER IMMUNOELECTROPHORESIS", "code_information": [{"code": "86325", "type": "CPT"}], "standard_charges": [{"minimum": 26.6, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [{"code": "868", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [{"code": "867", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "869", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [{"code": "922", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [{"code": "923", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 3504.91, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [{"code": "699", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [{"code": "698", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "700", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [{"code": "674", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [{"code": "673", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "675", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [{"code": "271", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "270", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "272", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC", "code_information": [{"code": "729", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "730", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC", "code_information": [{"code": "717", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "718", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "715", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "716", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [{"code": "887", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "964", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "963", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "965", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [{"code": "565", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [{"code": "564", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "566", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [{"code": "516", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC", "code_information": [{"code": "515", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "517", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [{"code": "844", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC", "code_information": [{"code": "843", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "845", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [{"code": "908", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [{"code": "907", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "909", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "958", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "957", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "959", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC", "code_information": [{"code": "803", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC", "code_information": [{"code": "802", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC", "code_information": [{"code": "804", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER ORAL PATHOLOGY PROCEDU", "code_information": [{"code": "D0502", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER POWER WHLCHR BASE", "code_information": [{"code": "K0014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "205", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 7700.44, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [{"code": "206", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [{"code": "167", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [{"code": "166", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "168", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [{"code": "580", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC", "code_information": [{"code": "579", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "581", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER SOURCE ALBUMIN QUAN EA", "code_information": [{"code": "82042", "type": "CPT"}], "standard_charges": [{"minimum": 8.95, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER SPECIFIED CASE MGMT", "code_information": [{"code": "G9012", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER TMJ IMAGES BY REPORT", "code_information": [{"code": "D0321", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.8, "maximum": 98.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 98.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [{"code": "253", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "252", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "254", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [{"code": "152", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [{"code": "153", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTOLARYNGOLOGY SS", "code_information": [{"code": "G4022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OUT OF OFFICE EMERG MED SERV", "code_information": [{"code": "99060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OUT-OF-HOSP ON CALL SERVICE", "code_information": [{"code": "99027", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OUTPT ED OBS W INPT ADMIT", "code_information": [{"code": "G2176", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OUTPT INJECT THERAPUETIC VISIT", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "11000219", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 99.52, "maximum": 157.14, "gross_charge": 174.6, "discounted_cash": 54.17, "estimated_discounted_cash": 250.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OUTPT IV INSULIN TX ANY MEA", "code_information": [{"code": "G9147", "type": "HCPCS"}], "standard_charges": [{"minimum": 1636.8, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OUTPT VISIT (NONPHY VISIT)", "code_information": [{"code": "99211", "type": "CPT"}, {"code": "10000004", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 97.07, "maximum": 153.27, "gross_charge": 170.31, "discounted_cash": 54.17, "estimated_discounted_cash": 155.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 127.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 136.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 153.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 97.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OUTSIDE STATE AMBULANCE SERV", "code_information": [{"code": "A0021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVER-BED TABLE", "code_information": [{"code": "E0274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVERDENTURE COMPLETE MANDIB", "code_information": [{"code": "D5865", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVERDENTURE COMPLETE MAX", "code_information": [{"code": "D5863", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVERDENTURE PARTIAL MANDIB", "code_information": [{"code": "D5866", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVERDENTURE PARTIAL MAX", "code_information": [{"code": "D5864", "type": "HCPCS"}], "standard_charges": [{"minimum": 981.28, "maximum": 981.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 981.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVINE, 1000 USP UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3472", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVINE, UP TO 999 USP UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3471", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVULATION MGMT PER CYCLE", "code_information": [{"code": "S4042", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OVULATION TESTS", "code_information": [{"code": "84830", "type": "CPT"}], "standard_charges": [{"minimum": 14.61, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXACILLIN SODIUM INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXALATE - 24 HOUR URINE", "code_information": [{"code": "83945", "type": "CPT"}, {"code": "1000523", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.62, "maximum": 68.58, "gross_charge": 76.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 60.96, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OXALIPLATIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9263", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXANDRIN (OXANDROLONE) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000427", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXCARBAZEPINE", "code_information": [{"code": "80299", "type": "CPT"}, {"code": "1000014", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 21.44, "maximum": 98.1, "gross_charge": 109.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OXFORD W SUPINAT/PRONAT INF", "code_information": [{"code": "L3201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXFORD W/ SUPINAT/PRONATOR C", "code_information": [{"code": "L3202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXFORD W/ SUPINATOR/PRONATOR", "code_information": [{"code": "L3203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXIMETER NON-INVASIVE", "code_information": [{"code": "E0445", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXY IR (OXYCODONE HCL IR) TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000956", "type": "CDM"}, {"code": "42858000301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXY IR (OXYCODONE HCL) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002662", "type": "CDM"}, {"code": "10702005601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXY IR (OXYCODONE HCL) 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000227", "type": "CDM"}, {"code": "42858000101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYCODONE HCL IR 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000353", "type": "CDM"}, {"code": "10702005701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYCODONE SR 10MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000352", "type": "CDM"}, {"code": "59011041010", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYCONTIN (OXYCODONE HCL CR) 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001073", "type": "CDM"}, {"code": "59011042010", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN 5-IN-1 CONNECTOR", "code_information": [{"code": "3001123", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN HUMIDIFIER", "code_information": [{"code": "3000205", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.34, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK AEROSOL ADULT", "code_information": [{"code": "3001321", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK AEROSOL PEDIATRIC", "code_information": [{"code": "3001320", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK AEROSOL W/TUBING", "code_information": [{"code": "3001388", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK AIR VENTURI ADULT", "code_information": [{"code": "3001323", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK INFANT", "code_information": [{"code": "3000235", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK LOCK ADULT % O2", "code_information": [{"code": "3000232", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK NONREBREATHER ADULT", "code_information": [{"code": "3000237", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK PED NONREBREATHER 3-IN-1", "code_information": [{"code": "3001312", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK PEDIATRIC", "code_information": [{"code": "3001300", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN MASK PEDIATRIC/CHILD", "code_information": [{"code": "3000236", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.57, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN NASAL CANNULA 25FT", "code_information": [{"code": "3000104", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.82, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN NASAL CANNULA 7FT", "code_information": [{"code": "3000103", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN NASAL CANNULA INFANT", "code_information": [{"code": "3001470", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN NASAL CANNULA PEDIATRIC", "code_information": [{"code": "3001461", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN NEBULIZER HAND-HELD", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "3001303", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 2.26, "maximum": 3.58, "gross_charge": 3.98, "discounted_cash": 54.17, "estimated_discounted_cash": 3.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OXYGEN PEAK FLOW MONITOR DISPOSABLE", "code_information": [{"code": "3000037", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 31.97, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN PROBE USED W OXIMETER", "code_information": [{"code": "A4606", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXYGEN SYSTEM GAS PORTABLE", "code_information": [{"code": "E0430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXYGEN SYSTEM LIQUID PORTABL", "code_information": [{"code": "E0435", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXYGEN SYSTEM LIQUID STATION", "code_information": [{"code": "E0440", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXYGEN TENT EXCL CROUP/PED T", "code_information": [{"code": "E0455", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXYGEN THERAPY RX", "code_information": [{"code": "4030F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXYGEN TUBING 25'", "code_information": [{"code": "3000381", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.12, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYGEN TUBING 7'", "code_information": [{"code": "3001419", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "OXYMORPHONE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXYTETRACYCLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OYSTER SHELL CALCIUM 500MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001124", "type": "CDM"}, {"code": "57896074101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Obecabtagene autoleucel, 10 up to 400 million CD19 CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per infusion", "code_information": [{"code": "Q2058", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Obstetrics (fetal antigen noninvasive prenatal test), cell-free DNA sequence analysis for detection of fetal presence or absence of 1 or more of the Rh, C, c, D, E, Duffy (Fya), or Kell (K) antigen in alloimmunized pregnancies, reported as selected antige", "code_information": [{"code": "488U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Obstetrics (preeclampsia), biochemical assay of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), serum, ratio reported for sFlt-1/PlGF, with risk of progression for preeclampsia with severe features within 2 weeks", "code_information": [{"code": "482U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Obstetrics (preeclampsia), sFlt-1/PlGF ratio, immunoassay, utilizing serum or plasma, reported as a value", "code_information": [{"code": "524U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Obstetrics (single-gene noninvasive prenatal test), cell-free DNA sequence analysis of 1 or more targets (eg, CFTR, SMN1, HBB, HBA1, HBA2) to identify paternally inherited pathogenic variants, and relative mutation-dosage analysis based on molecular count", "code_information": [{"code": "489U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (bladder), DNA, next-generation sequencing (NGS) of 60 genes and whole genome aneuploidy, urine, algorithms reported as minimal residual disease (MRD) status positive or negative and quantitative disease burden", "code_information": [{"code": "467U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (bladder), methylated PENK DNA detection by linear target enrichment-quantitative methylation-specific real-time PCR (LTE-qMSP), urine, reported as likelihood of bladder cancer", "code_information": [{"code": "452U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (breast cancer), S100A8 and S100A9, by enzyme-linked immunosorbent assay (ELISA), tear fluid with age, algorithm reported as a risk score", "code_information": [{"code": "458U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (breast), quantitative enzyme-linked immunosorbent assay (ELISA) for secreted breast cancer protein marker (BF9 antigen), serum, result reported as indicative of response/no response to therapy or disease progression/regression", "code_information": [{"code": "559U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (central nervous system), analysis of 30000 DNA methylation loci by methylation array, utilizing DNA extracted from tumor tissue, diagnostic algorithm reported as probability of matching a reference tumor subclass", "code_information": [{"code": "20M", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (cervix), mRNA gene expression profiling of 14 biomarkers (E6 and E7 of the highest-risk human papillomavirus [HPV] types 16, 18, 31, 33, 45, 52, 58), by real-time nucleic acid sequence-based amplification (NASBA), exo- or endocervical epithelial", "code_information": [{"code": "463U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal and lung), DNA from formalin-fixed paraffin-embedded (FFPE) tissue, next-generation sequencing of 8 genes (NRAS, EGFR, CTNNB1, PIK3CA, APC, BRAF, KRAS, and TP53), mutation detection", "code_information": [{"code": "499U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal cancer), analysis of cell-free DNA for epigenomic patterns, next-generation sequencing, >2500 differentially methylated regions (DMRs), plasma, algorithm reported as positive or negative", "code_information": [{"code": "537U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal cancer), cell-free DNA (cfDNA), methylation-based quantitative PCR assay (SEPTIN9, IKZF1, BCAT1, Septin9-2, VAV3, BCAN), plasma, reported as presence or absence of circulating tumor DNA (ctDNA)", "code_information": [{"code": "453U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal cancer), qualitative real-time PCR of 35 variants of KRAS and NRAS genes (exons 2, 3, 4), formalin-fixed paraffin-embedded (FFPE), predictive, identification of detected mutations", "code_information": [{"code": "471U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal) screening, quantitative real-time target and signal amplification, methylated DNA markers, including LASS4, LRRC4 and PPP2R5C, a reference marker ZDHHC1, and a protein marker (fecal hemoglobin), utilizing stool, algorithm reported as", "code_information": [{"code": "464U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal), blood, quantitative measurement of cell-free DNA (cfDNA)", "code_information": [{"code": "501U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal), cell-free DNA, 8 genes for mutations, 7 genes for methylation by real-time RT-PCR, and 4 proteins by enzyme-linked immunosorbent assay, blood, reported positive or negative for colorectal cancer or advanced adenoma risk", "code_information": [{"code": "496U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal), next-generation sequencing for mutation detection in 43 genes and methylation pattern in 45 genes, blood, and formalin-fixed paraffin-embedded (FFPE) tissue, report of variants and methylation pattern with interpretation", "code_information": [{"code": "498U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (colorectal), quantitative enzyme-linked immunosorbent assay (ELISA) for secreted colorectal cancer protein marker (BF7 antigen), using serum, result reported as indicative of response/no response to therapy or disease progression/regression", "code_information": [{"code": "558U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (cutaneous or uveal melanoma), circulating tumor cell selection, morphological characterization and enumeration based on differential CD146, high molecular-weight melanoma-associated antigen, CD34 and CD45 protein biomarkers, peripheral blood", "code_information": [{"code": "490U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (hepatocellular carcinoma), next-generation sequencing methylation pattern assay to detect 6626 epigenetic alterations, cell-free DNA, plasma, algorithm reported as cancer signal detected or not detected", "code_information": [{"code": "565U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (lung), qPCR-based analysis of 13 differentially methylated regions (CCDC181, HOXA7, LRRC8A, MARCHF11, MIR129-2, NCOR2, PANTR1, PRKCB, SLC9A3, TBR1_2, TRAP1, VWC2, ZNF781), pleural fluid, algorithm reported as a qualitative result", "code_information": [{"code": "566U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (minimal residual disease [MRD]), genomic sequence analysis, cell-free DNA, whole blood and tumor tissue, baseline assessment for design and construction of a personalized variant panel to evaluate current MRD and for comparison to subsequent MRD", "code_information": [{"code": "560U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (minimal residual disease [MRD]), genomic sequence analysis, cell-free DNA, whole blood, subsequent assessment with comparison to initial assessment to evaluate for MRD", "code_information": [{"code": "561U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (multiple myeloma), LC-MS/MS, peptide ion quantification, serum, results compared with baseline to determine monoclonal paraprotein abundance", "code_information": [{"code": "451U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (multiple myeloma), liquid chromatography with tandem mass spectrometry (LC-MS/MS), monoclonal paraprotein sequencing analysis, serum, results reported as baseline presence or absence of detectable clonotypic peptides", "code_information": [{"code": "450U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (non-small cell lung cancer), DNA and RNA, digital PCR analysis of 9 genes (EGFR, KRAS, BRAF, ALK, ROS1, RET, NTRK 1/2/3, ERBB2, and MET) in formalin-fixed paraffin-embedded (FFPE) tissue, interrogation for single-nucleotide variants, insertions/", "code_information": [{"code": "478U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (oropharyngeal), detection of minimal residual disease by next-generation sequencing (NGS) based quantitative evaluation of 8 DNA targets, cell-free HPV 16 and 18 DNA from plasma", "code_information": [{"code": "470U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (ovarian), DNA, whole-genome sequencing with 5-hydroxymethylcytosine (5hmC) enrichment, using whole blood or plasma, algorithm reported as cancer detected or not detected", "code_information": [{"code": "507U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (pan-solid tumor), ctDNA, utilizing plasma, next-generation sequencing (NGS) of 77 genes, 8 fusions, microsatellite instability, and tumor mutation burden, interpretative report for single-nucleotide variants, copy-number alterations, with therap", "code_information": [{"code": "530U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (pan-solid tumor), next-generation sequencing analysis of tumor methylation markers present in cell-free circulating tumor DNA, algorithm reported as quantitative measurement of methylation as a correlate of tumor fraction", "code_information": [{"code": "486U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (pancreas), 3 biomarkers (glucose, carcinoembryonic antigen, and gastricsin), pancreatic cyst lesion fluid, algorithm reported as categorical mucinous or non-mucinous", "code_information": [{"code": "573U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (pancreatic cancer), augmentative algorithmic analysis of 16 genes from previously sequenced RNA whole-transcriptome data, reported as probability of predicted molecular subtype", "code_information": [{"code": "510U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), analysis of circulating plasma proteins (tPSA, fPSA, KLK2, PSP94, and GDF15), germline polygenic risk score (60 variants), clinical information (age, family history of prostate cancer, prior negative prostate biopsy), algorithm report", "code_information": [{"code": "495U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), augmentative algorithmic analysis of digitized whole-slide imaging of histologic features for microsatellite instability (MSI) and homologous recombination deficiency (HRD) status, formalin-fixed paraffin-embedded (FFPE) tissue, repor", "code_information": [{"code": "513U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), augmentative algorithmic analysis of digitized whole-slide imaging of histologic features for microsatellite instability (MSI) status, formalin-fixed paraffin-embedded (FFPE) tissue, reported as increased or decreased probability of M", "code_information": [{"code": "512U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), high-throughput telomere length quantification by FISH, whole blood, diagnostic algorithm reported as risk of prostate cancer", "code_information": [{"code": "572U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), mRNA gene-expression profiling by real-time RT-PCR of 6 genes (FOXM1, MCM3, MTUS1, TTC21B, ALAS1, and PPP2CA), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a risk score for prostate cancer", "code_information": [{"code": "497U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (prostate), microRNA, single-nucleotide polymorphisms (SNPs) analysis by RT-PCR of 32 variants, using buccal swab, algorithm reported as a risk score", "code_information": [{"code": "534U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid organ neoplasia), targeted genomic sequence analysis panel of 361 genes, interrogation for gene fusions, translocations, or other rearrangements, using DNA from formalin-fixed paraffin-embedded (FFPE) tumor tissue, report of clinically sig", "code_information": [{"code": "444U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), DNA (80 genes) and RNA (10 genes), by next-generation sequencing, plasma, including single-nucleotide variants, insertions/deletions, copy-number alterations, microsatellite instability, and fusions, reported as clinically actionab", "code_information": [{"code": "571U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), DNA, qualitative, next-generation sequencing (NGS) of single-nucleotide variants (SNV) and insertion/deletions in 22 genes utilizing formalin-fixed paraffin-embedded tissue, reported as presence or absence of mutation(s), location ", "code_information": [{"code": "523U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), cell-free DNA and RNA by next-generation sequencing, interpretative report for germline mutations, clonal hematopoiesis of indeterminate potential, and tumor-derived single-nucleotide variants, small insertions/deletions, copy numb", "code_information": [{"code": "485U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), cell-free circulating DNA, targeted genomic sequence analysis panel of 84 genes, interrogation for sequence variants, aneuploidy-corrected gene copy number amplifications and losses, gene rearrangements, and microsatellite instabil", "code_information": [{"code": "487U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), cell-free circulating tumor DNA (ctDNA), 152 genes, next-generation sequencing, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, copy number alterations, and microsatellite instability, using", "code_information": [{"code": "539U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), circulating tumor cell selection, morphological characterization and enumeration based on differential epithelial cell adhesion molecule (EpCAM), cytokeratins 8, 18, and 19, CD45 protein biomarkers, and quantification of PD-L1 prot", "code_information": [{"code": "492U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), circulating tumor cell selection, morphological characterization and enumeration based on differential epithelial cell adhesion molecule (EpCAM), cytokeratins 8, 18, and 19, CD45 protein biomarkers, and quantification of estrogen r", "code_information": [{"code": "491U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), next-generation sequencing (NGS) of DNA from formalin-fixed paraffin-embedded (FFPE) tissue with comparative sequence analysis from a matched normal specimen (blood or saliva), 648 genes, interrogation for sequence variants, insert", "code_information": [{"code": "473U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), next-generation sequencing analysis of tumor methylation markers (>20000 differentially methylated regions) present in cell-free circulating tumor DNA (ctDNA), whole blood, algorithm reported as presence or absence of ctDNA with tu", "code_information": [{"code": "569U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), next-generation sequencing of DNA from formalin-fixed paraffin-embedded (FFPE) tissue of 517 genes, interrogation for single- nucleotide variants, multi-nucleotide variants, insertions and deletions from DNA, fusions in 24 genes an", "code_information": [{"code": "543U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), next-generation targeted sequencing analysis, formalin-fixed paraffin-embedded (FFPE) tumor tissue, DNA analysis of 600 genes, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, and copy number", "code_information": [{"code": "538U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), targeted genomic sequence analysis, 33 genes, detection of single-nucleotide variants (SNVs), insertions and deletions, copy-number amplifications, and translocations in human genomic circulating cell-free DNA, plasma, reported as ", "code_information": [{"code": "562U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (solid tumor), tumor cell culture in 3D microenvironment, 36 or more drug panel, reported as tumor-response prediction for each drug", "code_information": [{"code": "511U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (urothelial carcinoma), DNA, quantitative methylation-specific PCR of 2 genes (ONECUT2, VIM), algorithmic analysis reported as positive or negative", "code_information": [{"code": "465U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology (urothelial), DNA, quantitative methylated real-time PCR of TRNA-Cys, SIM2, and NKX1-1, using urine, diagnostic algorithm reported as a probability index for bladder cancer and/or upper tract urothelial carcinoma (UTUC)", "code_information": [{"code": "549U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology, pharmacogenomic analysis of single-nucleotide polymorphism (SNP) genotyping by real-time PCR of 24 genes, whole blood or buccal swab, with variant analysis, including impacted gene-drug interactions and reported phenotypes", "code_information": [{"code": "461U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology, spheroid cell culture, 11-drug panel (carboplatin, docetaxel, doxorubicin, etoposide, gemcitabine, niraparib, olaparib, paclitaxel, rucaparib, topotecan, veliparib) ovarian, fallopian, or peritoneal response prediction for each drug", "code_information": [{"code": "525U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oncology, whole blood or buccal, DNA single-nucleotide polymorphism (SNP) genotyping by real-time PCR of 24 genes, with variant analysis and reported phenotypes", "code_information": [{"code": "460U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Open implantation of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed", "code_information": [{"code": "908T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Optimal care for patients with urologic conditions MIPS value pathway", "code_information": [{"code": "M1423", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Orthopedic implant movement analysis using paired computed tomography (CT) examination of the target structure, including data acquisition, data preparation and transmission, interpretation and report (including CT scan of the joint or extremity performed", "code_information": [{"code": "946T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Overlay SL matrix, per square centimeter", "code_information": [{"code": "Q4352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "P-MASTECTOMY W/LN REMOVAL", "code_information": [{"code": "19302", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "P32 CHROMIC PHOSPHATE", "code_information": [{"code": "A9564", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "P32 NA PHOSPHATE", "code_information": [{"code": "A9563", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PABPN1 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81312", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PACER PAD", "code_information": [{"code": "3000257", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PACK MORTUARY SHROUD", "code_information": [{"code": "3000258", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PACKING STRIP PLAIN 1", "code_information": [{"code": "3000027", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PACKING STRIP PLAIN 1/2 X5", "code_information": [{"code": "3001380", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PACKING STRIP PLAIN 1/4 X5", "code_information": [{"code": "3001365", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.34, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PACLITAXEL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9267", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PACLITAXEL PROTEIN BOUND", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9264", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PADDING FOR COMPRSSN BDG", "code_information": [{"code": "S8430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAIN MGMT 11 ENDOGENOUS ANAL", "code_information": [{"code": "117U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAIN MGMT MRNA GEN XPRSN 36", "code_information": [{"code": "290U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALATAL LIFT PROSTHESIS", "code_information": [{"code": "D5955", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE FULL GENE SEQ", "code_information": [{"code": "81307", "type": "CPT"}], "standard_charges": [{"minimum": 777.98, "maximum": 777.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 777.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81308", "type": "CPT"}], "standard_charges": [{"minimum": 346.55, "maximum": 346.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 346.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALB2 MRNA SEQ ALYS", "code_information": [{"code": "137U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALIFERMIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2425", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALINGEN OR PALINGEN XPLUS", "code_information": [{"code": "Q4173", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALINGEN OR PROMATRX", "code_information": [{"code": "Q4174", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G0031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G0034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G0048", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G9988", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G9992", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G9993", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G9994", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "M1309", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALLIATIVE TX DENTAL PAIN", "code_information": [{"code": "D9110", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALM CONES", "code_information": [{"code": "3000259", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PALONOSETRON HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2469", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAMELOR (NORTRIPTYLINE) CAP 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000486", "type": "CDM"}, {"code": "00093081001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PAMELOR (NORTRIPTYLINE) CAP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000316", "type": "CDM"}, {"code": "00093081101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PAMIDRONATE DISODIUM /30 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAN MIST S 5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000118", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PANCREAS REMOVAL/TRANSPLANT", "code_information": [{"code": "48160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREAS TRANSPLANT", "code_information": [{"code": "10", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [{"code": "406", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "405", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "407", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48146", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48152", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48153", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48154", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREATORRHAPHY", "code_information": [{"code": "48545", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANITUMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9303", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANO RADIO IMAGE", "code_information": [{"code": "D0701", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANORAMIC IMAGE", "code_information": [{"code": "D0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 377.64, "maximum": 377.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 377.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANORAMIC X-RAY OF JAWS", "code_information": [{"code": "70355", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAP SMEAR", "code_information": [{"code": "88150", "type": "CPT"}, {"code": "1200002", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 18.31, "maximum": 55.12, "gross_charge": 43.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 34.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 39.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 24.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAPAVERIN HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2440", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAPER EXAM TABLE 21 X 225", "code_information": [{"code": "80000908", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 8.05, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PAPPA SERUM", "code_information": [{"code": "84163", "type": "CPT"}], "standard_charges": [{"minimum": 17.31, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARAFFIN BATH THERAPY", "code_information": [{"code": "97018", "type": "CPT"}], "standard_charges": [{"minimum": 5.36, "maximum": 103.18, "discounted_cash": 54.17, "estimated_discounted_cash": 29.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARAINFLUENZA AG IF", "code_information": [{"code": "87279", "type": "CPT"}], "standard_charges": [{"minimum": 18.89, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARAMED INTRCEPT NONVOL", "code_information": [{"code": "S0208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARAMEDICINTERCEP NONHOSPALS", "code_information": [{"code": "S0207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARANASAL SINUS ULTRASOUND", "code_information": [{"code": "S9024", "type": "HCPCS"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARASITE EXAMINATION WHOLE BLD", "code_information": [{"code": "87207", "type": "CPT"}, {"code": "1000975", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 6.89, "maximum": 30.6, "gross_charge": 34.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARASITE IDENTIFICATION", "code_information": [{"code": "87168", "type": "CPT"}, {"code": "1000260", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 4.91, "maximum": 47.41, "gross_charge": 52.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.14, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYR HOR INT", "code_information": [{"code": "83970", "type": "CPT"}, {"code": "1000508", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 47.47, "maximum": 219.88, "gross_charge": 244.32, "discounted_cash": 54.17, "estimated_discounted_cash": 244.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 47.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 195.45, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 219.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 139.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYR HOR REL PEP", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "1000696", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.16, "maximum": 71.98, "gross_charge": 79.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/SPECT&CT", "code_information": [{"code": "78072", "type": "CPT"}], "standard_charges": [{"minimum": 552.72, "maximum": 552.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 552.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/WO SUBTRJ", "code_information": [{"code": "78071", "type": "CPT"}], "standard_charges": [{"minimum": 417.56, "maximum": 417.56, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 417.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARATHYROID PLANAR IMAGING", "code_information": [{"code": "78070", "type": "CPT"}], "standard_charges": [{"minimum": 348.23, "maximum": 348.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 348.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SOL AMINO ACID 5.", "code_information": [{"code": "B4172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SOL HEPATIC FREAM", "code_information": [{"code": "B5200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SUPP NOT OTHRWS C", "code_information": [{"code": "B9999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARENTING CLASS", "code_information": [{"code": "S9444", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARICALCITOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARING BENIGN LESION TECH", "code_information": [{"code": "11055", "type": "CPT"}, {"code": "11000074", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES 2-4", "code_information": [{"code": "11056", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES >4", "code_information": [{"code": "11057", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42507", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42509", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42510", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART PULP FOR APEXOGENESIS", "code_information": [{"code": "D3222", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL HIP BONE DEEP", "code_information": [{"code": "27071", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF ANKLE/HEEL", "code_information": [{"code": "28120", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28111", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28112", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28113", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART REMOVE HIP BONE SUPER", "code_information": [{"code": "27070", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL AMPUTATION OF TOE", "code_information": [{"code": "28825", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC BONE HUMERUS", "code_information": [{"code": "24140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40500", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40510", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40520", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL HIP REPLACEMENT", "code_information": [{"code": "27125", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL HOSPITALIZATION SERV", "code_information": [{"code": "S0201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL HYSTERECTOMY", "code_information": [{"code": "58180", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL MASTECTOMY", "code_information": [{"code": "19301", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45113", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45123", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL RELEASE OF LUNG", "code_information": [{"code": "32225", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL COLLAR BONE", "code_information": [{"code": "23120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47141", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47142", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FINGER BONE", "code_information": [{"code": "26235", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FINGER BONE", "code_information": [{"code": "26236", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FOOT FASCIA", "code_information": [{"code": "28060", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL LEG BONE(S)", "code_information": [{"code": "27360", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51555", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44141", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44143", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44144", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44146", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44147", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43116", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43117", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43118", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43121", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43122", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43123", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67005", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67010", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FIBULA", "code_information": [{"code": "27641", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28122", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28288", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HAND BONE", "code_information": [{"code": "26230", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33030", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33031", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HYMEN", "code_information": [{"code": "56700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF KIDNEY", "code_information": [{"code": "50240", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31367", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31368", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31370", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31375", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31382", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIP", "code_information": [{"code": "40530", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47125", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LUNG", "code_information": [{"code": "32480", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF NOSE", "code_information": [{"code": "30150", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF OVARY(S)", "code_information": [{"code": "58920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PENIS", "code_information": [{"code": "54120", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PHARYNX", "code_information": [{"code": "42890", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RADIUS", "code_information": [{"code": "25151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RADIUS", "code_information": [{"code": "25230", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45111", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45114", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45116", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF SCAPULA", "code_information": [{"code": "23190", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF STERNUM", "code_information": [{"code": "21620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60220", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60225", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TIBIA", "code_information": [{"code": "27640", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28124", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28126", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28153", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28160", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41120", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41130", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25119", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25240", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF VULVA", "code_information": [{"code": "56620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL TEAR GLAND", "code_information": [{"code": "68505", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60210", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60212", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT ANTBDY SCRN", "code_information": [{"code": "86403", "type": "CPT"}], "standard_charges": [{"minimum": 13.27, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT ANTBDY TITR", "code_information": [{"code": "86406", "type": "CPT"}], "standard_charges": [{"minimum": 12.24, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARVO VIRUS B19 (HUMAN)", "code_information": [{"code": "86747", "type": "CPT"}, {"code": "1000188", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 17.28, "maximum": 96.7, "gross_charge": 88.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 71.18, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 80.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 50.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PASRR LEVEL I", "code_information": [{"code": "T2010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PASRR LEVEL II", "code_information": [{"code": "T2011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATADAY 0.2% OPTH SOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000809", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 257.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PATANOL 0.1% OPTH SUSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000765", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 282.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PATCH, LIDOCAINE/TETRACAINE", "code_information": [{"code": "C9285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ HIGH 41-60", "code_information": [{"code": "80505", "type": "CPT"}], "standard_charges": [{"minimum": 100.34, "maximum": 100.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 100.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ MOD 21-40", "code_information": [{"code": "80504", "type": "CPT"}], "standard_charges": [{"minimum": 53.24, "maximum": 53.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ PROLNG SVC", "code_information": [{"code": "80506", "type": "CPT"}], "standard_charges": [{"minimum": 47.79, "maximum": 47.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 47.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ SF 5-20", "code_information": [{"code": "80503", "type": "CPT"}], "standard_charges": [{"minimum": 24.91, "maximum": 24.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CONSLTJ DRG SURG", "code_information": [{"code": "88329", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 39.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CONSLTJ SURG 1 BLK 1SPC", "code_information": [{"code": "88331", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 111.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 111.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CONSLTJ SURG CYTO XM 1", "code_information": [{"code": "88333", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 101.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 101.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CONSLTJ SURG CYTO XM EA", "code_information": [{"code": "88334", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 61.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 61.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH CONSLTJ SURG EA ADD BLK", "code_information": [{"code": "88332", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 58.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH REPORT NOT SENT", "code_information": [{"code": "G9786", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH REPORT SENT", "code_information": [{"code": "G9785", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH RPRT W/ PT PN CAT ET AL", "code_information": [{"code": "3267F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH RPT MALIG CANCER DOCD", "code_information": [{"code": "3317F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH RPT MALIG CANCER DOCD", "code_information": [{"code": "3318F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH RPT TIS SPEC WLE/REEXC", "code_information": [{"code": "M1166", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH/CYST/TISSUE", "code_information": [{"code": "88304", "type": "CPT"}, {"code": "1200004", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 30.71, "maximum": 120.69, "gross_charge": 134.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 107.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 120.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 76.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH/DERM PROV 2ND BIOP OPIN", "code_information": [{"code": "G9784", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATH/TISSUE/CARCINOM", "code_information": [{"code": "88305", "type": "CPT"}, {"code": "1200005", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 30.71, "maximum": 129.6, "gross_charge": 144.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 76.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHO RPT INCL PT CTG", "code_information": [{"code": "G9428", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATHO RPT NO PT CTG", "code_information": [{"code": "G9431", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATHOGEN REDUCED PLASMA POOL", "code_information": [{"code": "P9070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATHOGEN REDUCED PLASMA SING", "code_information": [{"code": "P9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATHOGEN TEST FOR PLATELETS", "code_information": [{"code": "P9100", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [{"code": "543", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [{"code": "542", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "544", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PATHOLOGY MISCELLANE", "code_information": [{"code": "88305", "type": "CPT"}, {"code": "1200006", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 30.71, "maximum": 129.6, "gross_charge": 144.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 76.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHOLOGY SS", "code_information": [{"code": "G4023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATIENT EDUCATION MATERIALS", "code_information": [{"code": "99071", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATIENT IS DYSARTHRIC", "code_information": [{"code": "3762F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATIENT IS NOT DYSARTHRIC", "code_information": [{"code": "3763F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATIENT LIFT BATHROOM OR TOI", "code_information": [{"code": "E0625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATIENT PROGR, NEUROSTIM", "code_information": [{"code": "C1787", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATIENT RECORDED SPIROMETRY", "code_information": [{"code": "94014", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATIENT RECORDED SPIROMETRY", "code_information": [{"code": "94015", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATTERN ERG W/I&R", "code_information": [{"code": "509T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAVULON (PANCURONIUM) 4MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000783", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PAXIL (PAROXETINE) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000356", "type": "CDM"}, {"code": "13107015530", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PAXIL CR (PAROXETINE) TAB 12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000357", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PCA3/KLK3 ANTIGEN", "code_information": [{"code": "81313", "type": "CPT"}], "standard_charges": [{"minimum": 293.31, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 293.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PCP PROPHYLAX RXD 3MON LOW %", "code_information": [{"code": "4280F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PCP PROPHYLAXIS RXD", "code_information": [{"code": "4279F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PCV13 VACCINE IM", "code_information": [{"code": "90670", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PCV15 VACCINE IM", "code_information": [{"code": "90671", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PCV20 VACCINE IM", "code_information": [{"code": "90677", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PD CATHETER ANCHOR BELT", "code_information": [{"code": "A4653", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PDGFRA GENE", "code_information": [{"code": "81314", "type": "CPT"}], "standard_charges": [{"minimum": 378.94, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 378.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PDT DSTR PRMLG LES PHYS/QHP", "code_information": [{"code": "96573", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PDT DSTR PRMLG LES SKN", "code_information": [{"code": "96567", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEAK EXPIRATORY FLOW RATE (P", "code_information": [{"code": "S8110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI", "code_information": [{"code": "165U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI CLIN RX", "code_information": [{"code": "178U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED BLUNT HD TRAUM", "code_information": [{"code": "G0047", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED COMPR CARE PKG, PER DIEM", "code_information": [{"code": "T1025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED COMPR CARE PKG, PER HOUR", "code_information": [{"code": "T1026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 INIT", "code_information": [{"code": "99475", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 SUBSQ", "code_information": [{"code": "99476", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE TRANSPORT", "code_information": [{"code": "99466", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE TRANSPORT ADDL", "code_information": [{"code": "99467", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE INITIAL", "code_information": [{"code": "99471", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE SUBSQ", "code_information": [{"code": "99472", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CVC 4 FR KIT", "code_information": [{"code": "3000528", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PED CVC 5 FR KIT", "code_information": [{"code": "3000529", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PED DYNAMIC SEATING FRAME", "code_information": [{"code": "E2295", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED FBRL KD IFI27&MCEMP1 RNA", "code_information": [{"code": "389U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED GASTRO ED GIVEN CAREGVR", "code_information": [{"code": "4058F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC COMPL", "code_information": [{"code": "94774", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC DOWNLD", "code_information": [{"code": "94776", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC HK-UP", "code_information": [{"code": "94775", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC REPORT", "code_information": [{"code": "94777", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED HOSPITAL BED SEMI/ELECT", "code_information": [{"code": "E0329", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED HOSPITAL BED, MANUAL", "code_information": [{"code": "E0328", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED POWER WHEELCHAIR NOS", "code_information": [{"code": "E1239", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE BRIEF/DIAPER LG", "code_information": [{"code": "T4530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE BRIEF/DIAPER SM/MED", "code_information": [{"code": "T4529", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE PULL-ON LG", "code_information": [{"code": "T4532", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE PULL-ON SM/MED", "code_information": [{"code": "T4531", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED VSCLTS KD ALYS 3 BMRKS", "code_information": [{"code": "310U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED WHL GEN MTHYLTN ALYS 50+", "code_information": [{"code": "318U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEDCLE FH/CH/CH/M/N/AX/G/H/F", "code_information": [{"code": "15574", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEDIALYTE (ELECTROLYTE) ORAL 240ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000358", "type": "CDM"}, {"code": "70074080240", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 12.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEDIATRIC NEBULIZER CROUP", "code_information": [{"code": "3000636", "type": "CDM"}, {"code": "291", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEDIATRIC PARTIAL DENTURE FX", "code_information": [{"code": "D6985", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEDIATRIC SPEECH AID", "code_information": [{"code": "D5952", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEDIATRIC WHEELCHAIR NOS", "code_information": [{"code": "E1229", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEDIATRICS SS", "code_information": [{"code": "G4024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEDICLE E/N/E/L/NTRORAL", "code_information": [{"code": "15576", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEDICLE SOFT TISSUE GRAFT PR", "code_information": [{"code": "D4270", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEG INTERFERON ALFA-2A/180", "code_information": [{"code": "S0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEG INTERFERON ALFA-2B/10", "code_information": [{"code": "S0148", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEGADEMASE BOVINE, 25 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2504", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEGAPTANIB SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2503", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEGASPARGASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9266", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEGINESATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0890", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEGLOTICASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2507", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEGUNIGALSIDASE ALFA-IWXJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC", "code_information": [{"code": "734", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC", "code_information": [{"code": "735", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "57410", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "99459", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION", "code_information": [{"code": "45126", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FRACTURE UNI/BIL", "code_information": [{"code": "G0413", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FX TREAT INT FIX", "code_information": [{"code": "G0414", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEN V K (PENICILLIN V) TAB 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000114", "type": "CDM"}, {"code": "00781120501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PENICILLIN G POTASSIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENICILLIN G PROCAINE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENICILLIN V POTASSIUM SUSP 125MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000360", "type": "CDM"}, {"code": "00093412573", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PENICILLIN V SOLN 125MG/5ML*", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000480", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PENILE INJECTION", "code_information": [{"code": "54235", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93980", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93981", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENILE VENOUS OCCLUSION", "code_information": [{"code": "37790", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENIS PLASTIC SURGERY", "code_information": [{"code": "54360", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITH CC/MCC", "code_information": [{"code": "709", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "710", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54240", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENTAMIDINE COMP UNIT DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7676", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENTAMIDINE ISETHIONATE 300MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000990", "type": "CDM"}, {"code": "63323011310", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PENTAMIDINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2545", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENTASTARCH 10% SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2513", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENTAZOCINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENTOBARBITAL SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENTOSTATIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9268", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEPCID (FAMOTIDINE) 10MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004310", "type": "CDM"}, {"code": "00904552987", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEPCID (FAMOTIDINE) 20MG/2ML INJ", "drug_information": {"unit": 80.0, "type": "EA"}, "code_information": [{"code": "J1308", "type": "HCPCS"}, {"code": "7000187", "type": "CDM"}, {"code": "63323073912", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEPCID (FAMOTIDINE) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000188", "type": "CDM"}, {"code": "00904719361", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEPCID COMPLETE CHEW. TAB 10/800/165", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001029", "type": "CDM"}, {"code": "16837029125", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEPTO BISMOL (BISMUTH) SUSP 262MG/15ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000361", "type": "CDM"}, {"code": "37000003202", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT 65+ YR", "code_information": [{"code": "99397", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT INFANT", "code_information": [{"code": "99391", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS MR", "code_information": [{"code": "C7502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS STERO", "code_information": [{"code": "C7501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC CRYO ABLATE RENAL TUM", "code_information": [{"code": "50593", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO ADD", "code_information": [{"code": "C9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO SIN", "code_information": [{"code": "C9607", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG B", "code_information": [{"code": "C9605", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG S", "code_information": [{"code": "C9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC W AMI S", "code_information": [{"code": "C9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER BR", "code_information": [{"code": "C9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER S", "code_information": [{"code": "C9602", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT BRAN", "code_information": [{"code": "C9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT SING", "code_information": [{"code": "C9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENAL TUMOR", "code_information": [{"code": "50592", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERCOCET (OXYCODONE/APAP) TAB 10/325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000589", "type": "CDM"}, {"code": "47781023001", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PERCOCET (OXYCODONE/APAP) TAB 5/325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000794", "type": "CDM"}, {"code": "47781019601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PERCOCET (OXYCODONE/APAP) TAB 7.5/325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000999", "type": "CDM"}, {"code": "31722095001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PERCUT ABLATE LIVER RF", "code_information": [{"code": "47382", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERCUT ALLERGY SKIN TESTS", "code_information": [{"code": "95004", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [{"code": "273", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [{"code": "274", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES", "code_information": [{"code": "321", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "322", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [{"code": "250", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "251", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS ISLET CELLTRANS", "code_information": [{"code": "G0341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERF ULTRSND TO LCT PREG DOC", "code_information": [{"code": "G8806", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAND", "code_information": [{"code": "D5996", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAX", "code_information": [{"code": "D5995", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERI WASH", "code_information": [{"code": "3000262", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PERI-IMPLT CAPSLC BRST COMPL", "code_information": [{"code": "19371", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERI-PX DEV EVAL ISDSS IP", "code_information": [{"code": "684T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERI-PX DEVICE EVAL & PRGR", "code_information": [{"code": "93287", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERI-PX EVAL PM/LDLS PM IP", "code_information": [{"code": "93286", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIACETABULAR OSTEOTOMY", "code_information": [{"code": "S2115", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIACTIN (CYPROHEPTADINE) TAB 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000323", "type": "CDM"}, {"code": "70752010710", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS W/IMAGING", "code_information": [{"code": "33016", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIGUARD SKIN PROTECTANT 3.5OZ", "code_information": [{"code": "3001296", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PERIODIC ASSESSMENT", "code_information": [{"code": "G2077", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIODIC ORAL EVALUATION", "code_information": [{"code": "D0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIODIC ORTHODONTC TX VISIT", "code_information": [{"code": "D8670", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL MAINT PROCEDURES", "code_information": [{"code": "D4910", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL SCALING & ROOT", "code_information": [{"code": "D4341", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL SCALING 1-3TEETH", "code_information": [{"code": "D4342", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIOPIC IMAGE CAPTURE ONLY", "code_information": [{"code": "D0389", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIP NERVE BLOCK", "code_information": [{"code": "G9770", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR REHAB", "code_information": [{"code": "93668", "type": "CPT"}], "standard_charges": [{"minimum": 534.79, "maximum": 534.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 534.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [{"code": "41", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [{"code": "40", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "42", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERITON DIALYSIS PLAN DOCD", "code_information": [{"code": "507F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [{"code": "336", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [{"code": "335", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC", "code_information": [{"code": "337", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERITONEAL DIALYSIS CLAMP", "code_information": [{"code": "E1634", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERITONEAL LAVAGE", "code_information": [{"code": "49084", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [{"code": "243", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [{"code": "242", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC", "code_information": [{"code": "244", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PERMANENT TEAR DUCT PLUG", "code_information": [{"code": "A4263", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMEADERM B, PER SQ CM", "code_information": [{"code": "A2016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMEADERM C, PER SQ CM", "code_information": [{"code": "A2018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMEADERM GLOVE, EACH", "code_information": [{"code": "A2017", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMETHRIN CREAM 5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001948", "type": "CDM"}, {"code": "21922002107", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 56.97, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PERPHENAZINE 4MG ORAL", "code_information": [{"code": "Q0175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ & ICUT ALLG TEST VENOMS", "code_information": [{"code": "95017", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ ABLTJ LVR CRYOABLATION", "code_information": [{"code": "47383", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ ACCESS & CLSR FEM ART", "code_information": [{"code": "34713", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ ART M-THROMBECT &/NFS", "code_information": [{"code": "61645", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ CERVICOTHORACIC INJECT", "code_information": [{"code": "22510", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ CLSR TCAT L ATR APNDGE", "code_information": [{"code": "33340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ CVT&LS INJ VERT BODIES", "code_information": [{"code": "C7504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST MR GUIDE", "code_information": [{"code": "19287", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST STRTCTC", "code_information": [{"code": "19283", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST US IMAG", "code_information": [{"code": "19285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [{"code": "19288", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD STRTCTC", "code_information": [{"code": "19284", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD US IMAG", "code_information": [{"code": "19286", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST 1ST IMAG", "code_information": [{"code": "19281", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST EA IMAG", "code_information": [{"code": "19282", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ IMPLTJ/RPLCMT ISDNS PTN", "code_information": [{"code": "587T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ ISLET CELL TRANSPLANT", "code_information": [{"code": "584T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM CRV/THRC", "code_information": [{"code": "274T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM LUMBAR", "code_information": [{"code": "275T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LS&CVT INJ VERT BODIES", "code_information": [{"code": "C7505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LUMB&THOR VERT AUG", "code_information": [{"code": "C7508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LUMBOSACRAL INJECTION", "code_information": [{"code": "22511", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR 1ST", "code_information": [{"code": "629T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR EA", "code_information": [{"code": "630T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR 1ST", "code_information": [{"code": "627T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR EA", "code_information": [{"code": "628T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP CPLX>2CM", "code_information": [{"code": "50081", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP SMPL<2CM", "code_information": [{"code": "50080", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR BI", "code_information": [{"code": "33903", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR UNI", "code_information": [{"code": "33902", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT BI", "code_information": [{"code": "33901", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT UNI", "code_information": [{"code": "33900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC EACH ADDL", "code_information": [{"code": "33904", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47538", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47539", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ PRCRD DRG INSJ CATH CT", "code_information": [{"code": "33019", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT BILAT INJ", "code_information": [{"code": "201T", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT UNILAT INJ", "code_information": [{"code": "200T", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ STENT/CHEST VERT ART", "code_information": [{"code": "75T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT INTRATRL SEPTL SHT", "code_information": [{"code": "613T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT US ABLTJ NRV P-ART", "code_information": [{"code": "632T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ THOR&LUMB VERT AUG", "code_information": [{"code": "C7507", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE EACH", "code_information": [{"code": "93592", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE PDA", "code_information": [{"code": "93582", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS AORTIC", "code_information": [{"code": "93591", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS MITRAL", "code_information": [{"code": "93590", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH SEPTAL REDUXN", "code_information": [{"code": "93583", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML ANGP NT/RECR COA", "code_information": [{"code": "33897", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML CORONRY LITHOTRP", "code_information": [{"code": "92972", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TX MALAR FRACTURE", "code_information": [{"code": "21355", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TX NASOETHMOID FX", "code_information": [{"code": "21340", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22513", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22514", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22515", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ&IC ALLG TEST DRUGS/BIOL", "code_information": [{"code": "95018", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERSANTINE (DIPYRIDAMOLE) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000164", "type": "CDM"}, {"code": "64980013301", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PERSIST ASTHMA MEDICINE CTRL", "code_information": [{"code": "4015F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERSISTENT ASTHMA", "code_information": [{"code": "1038F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERSONAL CARE ITEM NOS EACH", "code_information": [{"code": "S5199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERSONAL CARE SER PER 15 MIN", "code_information": [{"code": "T1019", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERSONAL CARE SER PER DIEM", "code_information": [{"code": "T1020", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERSONALIZED INTERBODY CAGE", "code_information": [{"code": "C1831", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERTUSSIS AG IF", "code_information": [{"code": "87265", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERTUZU, TRASTUZU, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9316", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET DX FOR NON-TUMOR ID, NOC", "code_information": [{"code": "A9598", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMAGE FULL BODY", "code_information": [{"code": "78813", "type": "CPT"}], "standard_charges": [{"minimum": 858.29, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 858.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMAGE LTD AREA", "code_information": [{"code": "78811", "type": "CPT"}], "standard_charges": [{"minimum": 757.42, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 757.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMAGE SKULL-THIGH", "code_information": [{"code": "78812", "type": "CPT"}], "standard_charges": [{"minimum": 859.46, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 859.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT FULL BODY", "code_information": [{"code": "78816", "type": "CPT"}], "standard_charges": [{"minimum": 862.56, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 862.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT LMTD", "code_information": [{"code": "78814", "type": "CPT"}], "standard_charges": [{"minimum": 861.4, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 861.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT SKULL-THIGH", "code_information": [{"code": "78815", "type": "CPT"}], "standard_charges": [{"minimum": 863.15, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 863.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMAGING INITIAL DX", "code_information": [{"code": "G0252", "type": "HCPCS"}], "standard_charges": [{"minimum": 4178.59, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMG WHOLBOD MELANO NONCO", "code_information": [{"code": "G0219", "type": "HCPCS"}], "standard_charges": [{"minimum": 4178.59, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET NOT OTHERWISE SPECIFIED", "code_information": [{"code": "G0235", "type": "HCPCS"}], "standard_charges": [{"minimum": 4178.59, "maximum": 4178.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4178.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET, DX, FOR TUMOR ID, NOC", "code_information": [{"code": "A9597", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFAS 16 PFAS COMPND LC MS/MS", "code_information": [{"code": "398U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFAS 16 PFAS COMPND LC MS/MS", "code_information": [{"code": "399U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFIZER VACC ADM PED 1ST DOSE", "code_information": [{"code": "D1713", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFIZER VACC ADM PED 2ND DOSE", "code_information": [{"code": "D1714", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFIZER VACC ADMIN 1ST DOSE", "code_information": [{"code": "D1701", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFIZER VACC ADMIN 2ND DOSE", "code_information": [{"code": "D1702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFIZER VACC ADMIN 3RD DOSE", "code_information": [{"code": "D1708", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFIZER VACCINE ADMIN BOOSTER", "code_information": [{"code": "D1709", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHAKIC IOL REFRACTIVE ERROR", "code_information": [{"code": "S0596", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHARM THER OSTEO RX", "code_information": [{"code": "G8633", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHARM THX FOR OP RXD", "code_information": [{"code": "4005F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHARMACIST AT HOSPICE", "code_information": [{"code": "G9479", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHARMACOLOGIC MGMT W/PSYTX", "code_information": [{"code": "90863", "type": "CPT"}], "standard_charges": [{"minimum": 109.09, "maximum": 109.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 109.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHARMACY COMP/DISP SERV", "code_information": [{"code": "S9430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHAZYME (SIMETHICONE) CAP 180MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000362", "type": "CDM"}, {"code": "70000056601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENERGAN (PROMETHAZ) 25MG IM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2550", "type": "HCPCS"}, {"code": "72000539", "type": "CDM"}, {"code": "00641092825", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 16.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENERGAN (PROMETHAZ) 25MG/100 ML NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2550", "type": "HCPCS"}, {"code": "72000386", "type": "CDM"}, {"code": "00641149535", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 16.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENERGAN (PROMETHAZ) 50MG IM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2550", "type": "HCPCS"}, {"code": "72000538", "type": "CDM"}, {"code": "39822555006", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 16.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENERGAN (PROMETHAZ) 6.25MG/5ML SYRP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000391", "type": "CDM"}, {"code": "63629187001", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 27.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENERGAN (PROMETHAZ) SUPP 12.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000395", "type": "CDM"}, {"code": "00713053612", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENERGAN (PROMETHAZ) SUPP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000257", "type": "CDM"}, {"code": "00713052612", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 16.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENERGAN (PROMETHAZ) SUPP 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000256", "type": "CDM"}, {"code": "00713013212", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 51.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENERGAN (PROMETHAZ) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000392", "type": "CDM"}, {"code": "53746052101", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENERGAN/CODEINE LIQ 10MG/6.25MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000415", "type": "CDM"}, {"code": "27808006502", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENOBARBITAL", "code_information": [{"code": "80184", "type": "CPT"}, {"code": "1000189", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.6, "maximum": 61.02, "gross_charge": 67.8, "discounted_cash": 54.17, "estimated_discounted_cash": 67.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.24, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOBARBITAL 65MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2560", "type": "HCPCS"}, {"code": "72000345", "type": "CDM"}, {"code": "00641047625", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.74, "maximum": 18.54, "gross_charge": 20.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOBARBITAL 97.2MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001117", "type": "CDM"}, {"code": "00603516821", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENOBARBITAL TAB 16.2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000265", "type": "CDM"}, {"code": "13517062501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENOBARBITAL TAB 32.4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000144", "type": "CDM"}, {"code": "00904657561", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENOBARBITAL TAB 64.8MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000231", "type": "CDM"}, {"code": "16571066701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHENOTYPE (PER ANTIGEN)", "code_information": [{"code": "86905", "type": "CPT"}, {"code": "1400013", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.4, "maximum": 581.66, "gross_charge": 646.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 517.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 581.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 368.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE DNA HIV W/CLT ADD", "code_information": [{"code": "87904", "type": "CPT"}], "standard_charges": [{"minimum": 29.98, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE DNA HIV W/CULTURE", "code_information": [{"code": "87903", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 561.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 561.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE INFECT AGENT DRUG", "code_information": [{"code": "87900", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 149.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 149.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHENTOLAINE MESYLATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2760", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHENYLEP KETOROLAC OPTH SOLN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1097", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHILADELPHIA COLLAR ADULT LG", "code_information": [{"code": "3001150", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHILADELPHIA COLLAR CHILD", "code_information": [{"code": "3001149", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHLEB VEINS - EXTREM 20+", "code_information": [{"code": "37766", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHLEBOTOMY", "code_information": [{"code": "99195", "type": "CPT"}, {"code": "1000071", "type": "CDM"}, {"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 84.01, "maximum": 132.65, "gross_charge": 147.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 110.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 117.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 132.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 84.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOENIX WND MTRX, PER SQ CM", "code_information": [{"code": "A2015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOS URINE 24/RDM", "code_information": [{"code": "84105", "type": "CPT"}, {"code": "1000524", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.65, "maximum": 27.56, "gross_charge": 30.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSLO (CALCIUM ACET) CAP 667MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000150", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHOSPHORUS SERUM", "code_information": [{"code": "84100", "type": "CPT"}, {"code": "1000192", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.45, "maximum": 25.27, "gross_charge": 28.08, "discounted_cash": 54.17, "estimated_discounted_cash": 28.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTO PATCH TEST", "code_information": [{"code": "95052", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY UV-A OR B", "code_information": [{"code": "96913", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-A", "code_information": [{"code": "96912", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-B", "code_information": [{"code": "96910", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTODYNAMIC TX ADDL 15 MIN", "code_information": [{"code": "96571", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTODYNMC TX 30 MIN ADD-ON", "code_information": [{"code": "96570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTOPHERESIS", "code_information": [{"code": "36522", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTOREFRACTIVE KERATECTOMY", "code_information": [{"code": "S0810", "type": "HCPCS"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTOSENSITIVITY TESTS", "code_information": [{"code": "95056", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHOTOTHERAP KERATECT", "code_information": [{"code": "S0812", "type": "HCPCS"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHP/IOP OT SERVICE", "code_information": [{"code": "G0129", "type": "HCPCS"}], "standard_charges": [{"minimum": 589.34, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/MNTR", "code_information": [{"code": "94626", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/O MNTR", "code_information": [{"code": "94625", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV AUTHRJ", "code_information": [{"code": "86079", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 55.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV REACTJ", "code_information": [{"code": "86078", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 55.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV XMATCH", "code_information": [{"code": "86077", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 55.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYS EXAM FOR COLLEGE", "code_information": [{"code": "S0622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYS REM SUT AND STAP", "code_information": [{"code": "15854", "type": "CPT"}, {"code": "11001255", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 33.56, "maximum": 53.0, "gross_charge": 58.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 47.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 53.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 33.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS REM SUT OR STAP", "code_information": [{"code": "15853", "type": "CPT"}, {"code": "11001250", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 26.41, "maximum": 41.71, "gross_charge": 46.35, "discounted_cash": 54.17, "estimated_discounted_cash": 46.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 37.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 26.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS REVIEW OF MOTION TESTS", "code_information": [{"code": "96004", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYS/OCC THERAPY SS", "code_information": [{"code": "G4026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYSICAL MEDICINE SS", "code_information": [{"code": "G4025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYSICAL PERF TEST/MEASUREMENT", "code_information": [{"code": "4000029", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 106.32, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PHYSICAL PERFORMANCE TEST", "code_information": [{"code": "97750", "type": "CPT"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYSICIAN STANDBY SERVICES", "code_information": [{"code": "99360", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PI VOLUNTEER AMBULANCE CO", "code_information": [{"code": "A0432", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PICC LINE DRESSING CHANGE KIT", "code_information": [{"code": "3001371", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PICC LINE SECUREMENT DRESSING", "code_information": [{"code": "3001394", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.97, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PICK/HAIR", "code_information": [{"code": "3001464", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 0.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PIERCE EARLOBES", "code_information": [{"code": "69090", "type": "CPT"}], "standard_charges": [{"minimum": 2028.36, "maximum": 2028.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2028.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61253", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & REMOVE CLOT", "code_information": [{"code": "61154", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR BIOPSY", "code_information": [{"code": "61140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61156", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL IMPLANT DEVICE", "code_information": [{"code": "61210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIFLU F-18, DIA 1 MILLICURIE", "code_information": [{"code": "A9595", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIK3CA GENE TRGT SEQ ALYS", "code_information": [{"code": "81309", "type": "CPT"}], "standard_charges": [{"minimum": 316.05, "maximum": 316.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PILD/PLACEBO CONTROL CLIN TR", "code_information": [{"code": "G0276", "type": "HCPCS"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PILLOW DISPOSABLE", "code_information": [{"code": "3000038", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PILOCAR (PILOCARPINE) 2% DROP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000364", "type": "CDM"}, {"code": "61314020415", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PIN FINGER DISLOCATION", "code_information": [{"code": "26776", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIN FINGER FRACTURE EACH", "code_information": [{"code": "26756", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIN HAND DISLOCATION", "code_information": [{"code": "26676", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIN KNUCKLE DISLOCATION", "code_information": [{"code": "26706", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIN RADIOULNAR DISLOCATION", "code_information": [{"code": "25671", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIN SERVICE 60M PER MONTH", "code_information": [{"code": "G0023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIN SRV ADD 30 MIN PR M", "code_information": [{"code": "G0024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIN ULNAR STYLOID FRACTURE", "code_information": [{"code": "25651", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PINCH GRAFT UP TO 2 CM DIAM", "code_information": [{"code": "15050", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}], "standard_charges": [{"minimum": 4.91, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAMINATIONS", "code_information": [{"code": "Q0113", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PITCHER WATER", "code_information": [{"code": "3001051", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PITOCIN (OXYTOCIN) 10U/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2590", "type": "HCPCS"}, {"code": "7000354", "type": "CDM"}, {"code": "63323001211", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 26.56, "maximum": 41.94, "gross_charge": 46.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 37.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 41.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 26.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PITUITARY EVALUATION PANEL", "code_information": [{"code": "80418", "type": "CPT"}], "standard_charges": [{"minimum": 103.37, "maximum": 666.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 666.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PJP PROPH ORDERED CD4 LOW", "code_information": [{"code": "G9223", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST CATH FOR RAD", "code_information": [{"code": "19297", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST RAD TUBE/CATHS", "code_information": [{"code": "19298", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTD ART", "code_information": [{"code": "36224", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36222", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36223", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATH INTRACRANIAL ART", "code_information": [{"code": "36228", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATH SUBCLAVIAN ART", "code_information": [{"code": "36225", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATH THORACIC AORTA", "code_information": [{"code": "36221", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATH VERTEBRAL ART", "code_information": [{"code": "36226", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATH XTRNL CAROTID", "code_information": [{"code": "36227", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN AORTA", "code_information": [{"code": "36200", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36013", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36014", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36015", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36215", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36216", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36217", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36218", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36010", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36011", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36012", "type": "CPT"}], "standard_charges": [{"minimum": 13139.43, "maximum": 13139.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13139.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE CECOSTOMY TUBE PERC", "code_information": [{"code": "49442", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE IMPACTED TOOTH", "code_information": [{"code": "D7283", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE/MARKER, NON PRO", "code_information": [{"code": "C9728", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49441", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE ENDORECTAL APP", "code_information": [{"code": "C9725", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43831", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43832", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE PERC", "code_information": [{"code": "49440", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE INTRA-SOCKET BIO DRESS", "code_information": [{"code": "D7922", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE NDL MUSC/TIS FOR RT", "code_information": [{"code": "20555", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLE IN VEIN", "code_information": [{"code": "36000", "type": "CPT"}], "standard_charges": [{"minimum": 2028.36, "maximum": 2028.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2028.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES H&N FOR RT", "code_information": [{"code": "41019", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES PELVIC FOR RT", "code_information": [{"code": "55920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE PERM PACING CARDIOVERT", "code_information": [{"code": "G0448", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE PO BREAST CATH FOR RAD", "code_information": [{"code": "19296", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE RT DEVICE/MARKER PROS", "code_information": [{"code": "55876", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACEMENT BILE DUCT SUPPORT", "code_information": [{"code": "47801", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF DRAIN PANCREAS", "code_information": [{"code": "48001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF SETON", "code_information": [{"code": "46020", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACEMNT REMOVABLE APPLIANCE", "code_information": [{"code": "D9939", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACENTAL LACTOGEN", "code_information": [{"code": "83632", "type": "CPT"}], "standard_charges": [{"minimum": 23.25, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLAELET RICH PLASMA UNIT", "code_information": [{"code": "P9020", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLAN 2 MAIN DR BY 1 MONTH", "code_information": [{"code": "5050F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLAN CARE LIPID CONTROL DOCD", "code_information": [{"code": "556F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLAN CAREMNG ANGNL SYMPTDOCD", "code_information": [{"code": "557F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLAN OF CARE 4 PAIN DOCD", "code_information": [{"code": "521F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLANAR BACK FOR PED SIZE WC", "code_information": [{"code": "E2291", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLANAR SEAT FOR PED SIZE WC", "code_information": [{"code": "E2292", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLAND CHEMO DOCD B/4 TXMNT", "code_information": [{"code": "519F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLAQUENIL (HYDROXYCHLOROQUINE SUL) 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000722", "type": "CDM"}, {"code": "00904704606", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PLASMA 1 DONOR FRZ W/IN 8 HR", "code_information": [{"code": "P9017", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLASMA CRYO REDU PATH EACH", "code_information": [{"code": "P9025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLASMA FRESH FROZEN", "code_information": [{"code": "86927", "type": "CPT"}], "standard_charges": [{"minimum": 20.5, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLASMA LYTE M DEXT 5", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200013", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PLASMA PROTEIN FRACT,5%,50ML", "code_information": [{"code": "P9043", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME MULTIPLE", "code_information": [{"code": "78111", "type": "CPT"}], "standard_charges": [{"minimum": 92.5, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 92.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME SINGLE", "code_information": [{"code": "78110", "type": "CPT"}], "standard_charges": [{"minimum": 86.95, "maximum": 86.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 86.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLASMAPROTEIN FRACT,5%,250ML", "code_information": [{"code": "P9048", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLASTAZOTE SANDAL EACH", "code_information": [{"code": "L3265", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY SS", "code_information": [{"code": "G4027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATE PHERES LEUKOREDU IRRAD", "code_information": [{"code": "P9037", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELET ANTIBODIES", "code_information": [{"code": "86022", "type": "CPT"}], "standard_charges": [{"minimum": 21.13, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELET DEPLETE OF HARVEST", "code_information": [{"code": "38213", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELET PHERES LEUKOREDUCED", "code_information": [{"code": "P9035", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELET SURVIVAL", "code_information": [{"code": "78191", "type": "CPT"}], "standard_charges": [{"minimum": 157.2, "maximum": 157.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELETS LEUKOCYTES REDUCED", "code_information": [{"code": "P9031", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELETS LEUKOREDUCED IRRAD", "code_information": [{"code": "P9033", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELETS PHERESIS PATH REDU", "code_information": [{"code": "P9073", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELETS, HLA-M, L/R, UNIT", "code_information": [{"code": "P9052", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELETS, IRRADIATED", "code_information": [{"code": "P9032", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATELETS, PHERESIS", "code_information": [{"code": "P9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLAVIX (CLOPIDOGREL BISULFAT) TAB 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000365", "type": "CDM"}, {"code": "67877027690", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PLCG2 GENE COMMON VARIANTS", "code_information": [{"code": "81320", "type": "CPT"}], "standard_charges": [{"minimum": 335.06, "maximum": 335.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 335.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLERIXAFOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2562", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLETAL (CILOSTAZOL) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000366", "type": "CDM"}, {"code": "00093206506", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PLEUR-EVAC ADULT A-4", "code_information": [{"code": "3000264", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH CC", "code_information": [{"code": "187", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH MCC", "code_information": [{"code": "186", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITHOUT CC/MCC", "code_information": [{"code": "188", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PLICAMYCIN (MITHRAMYCIN) INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9270", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT ACCESS BIL TREE SM BWL", "code_information": [{"code": "47541", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47533", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47534", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROSTOMY CATHETER", "code_information": [{"code": "50432", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROURETERAL CATHETER", "code_information": [{"code": "50433", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT ADDL", "code_information": [{"code": "222T", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT CERV", "code_information": [{"code": "219T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT LUMB", "code_information": [{"code": "221T", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT THOR", "code_information": [{"code": "220T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV 1ST", "code_information": [{"code": "10035", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV EA", "code_information": [{"code": "10036", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50693", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50694", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50695", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT XTN PROSTH EVASC RPR", "code_information": [{"code": "34709", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLNNING PT SPEC FENEST GRAFT", "code_information": [{"code": "34839", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLT, APH/PHER, L/R, CMV-NEG", "code_information": [{"code": "P9055", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLT, PHER, L/R CMV-NEG, IRR", "code_information": [{"code": "P9053", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLUMB/ELEC WK HM HEMO EQUIP", "code_information": [{"code": "A4870", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL DUAL", "code_information": [{"code": "93280", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL MULTI", "code_information": [{"code": "93281", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PM PHONE R-STRIP DEVICE EVAL", "code_information": [{"code": "93293", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMKR, DUAL, NON RATE-RESP", "code_information": [{"code": "C2619", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMKR, DUAL, RATE-RESP", "code_information": [{"code": "C1785", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMKR, OTHER THAN SING/DUAL", "code_information": [{"code": "C2621", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMKR, SINGLE, NON RATE-RESP", "code_information": [{"code": "C2620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMKR, SINGLE, RATE-RESP", "code_information": [{"code": "C1786", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA 1 BREAKPOINT", "code_information": [{"code": "81316", "type": "CPT"}], "standard_charges": [{"minimum": 238.41, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA COM BREAKPOINTS", "code_information": [{"code": "81315", "type": "CPT"}], "standard_charges": [{"minimum": 238.41, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE DUP/DELET", "code_information": [{"code": "81324", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 872.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 872.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE FULL SEQUENCE", "code_information": [{"code": "81325", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 885.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 885.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE KNOWN FAM VARIANT", "code_information": [{"code": "81326", "type": "CPT"}], "standard_charges": [{"minimum": 53.59, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE DUP/DELET VARIANTS", "code_information": [{"code": "81319", "type": "CPT"}], "standard_charges": [{"minimum": 234.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 234.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE FULL SEQ ANALYSIS", "code_information": [{"code": "81317", "type": "CPT"}], "standard_charges": [{"minimum": 777.98, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 777.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMS2 KNOWN FAMILIAL VARIANTS", "code_information": [{"code": "81318", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 380.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PMS2 MRNA SEQ ALYS", "code_information": [{"code": "161U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNE FLU HEPB COV HOME ADMIN", "code_information": [{"code": "M0201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNE NOT GIVEN NORSN", "code_information": [{"code": "G9280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNE SCRN DONE DOC NOT IND", "code_information": [{"code": "G9281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNE SCRN DONE DOC VAC DONE", "code_information": [{"code": "G9279", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNEUM VAX ADMIN 19+", "code_information": [{"code": "M1305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNEUMO IMM STATUS ASSESS", "code_information": [{"code": "1022F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNEUMOC VAC/ADMIN/RCVD", "code_information": [{"code": "4040F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNEUMOCOCCAL VACCINE ADMIN", "code_information": [{"code": "G8864", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNEUMOCYSTIS CARINII AG IF", "code_information": [{"code": "87281", "type": "CPT"}], "standard_charges": [{"minimum": 13.78, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH CC", "code_information": [{"code": "200", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH MCC", "code_information": [{"code": "199", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITHOUT CC/MCC", "code_information": [{"code": "201", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PNEUMOVAX 23 (PNEUMOCOCCAL) INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "90732", "type": "CPT"}, {"code": "7000367", "type": "CDM"}, {"code": "00006483703", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 68.4, "maximum": 108.0, "gross_charge": 120.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNXR ASPIR ABSC HMTMA BULLA", "code_information": [{"code": "10160", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PODIATRY SS", "code_information": [{"code": "G4028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [{"code": "917", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [{"code": "918", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POLIOVIRUS IPV SC/IM", "code_information": [{"code": "90713", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLY VITAMIN DROPS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000394", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POLYCARB LENS", "code_information": [{"code": "S0580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLYCYTE, TOPICAL ONLY 0.5CC", "code_information": [{"code": "Q4241", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLYHIST DM (DM/PE/PYRIL) LIQ 5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200086", "type": "CDM"}, {"code": "50991022016", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POLYMEM DRESSING 4X5 ADHES", "code_information": [{"code": "3001197", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 11.62, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POLYMEM DRESSING 5X5", "code_information": [{"code": "3001240", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POLYMEM WIC 3X3", "code_information": [{"code": "3001444", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.21, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POLYMYXIN B/TRIMETHOPRIM OPHTH SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004299", "type": "CDM"}, {"code": "61314062810", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 19.77, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POLYSOM 6/> YRS 4/> PARAM", "code_information": [{"code": "95810", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLYSOM 6/>YRS CPAP 4/> PARM", "code_information": [{"code": "95811", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS 4/> PARAMTRS", "code_information": [{"code": "95782", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS CPAP/BILVL", "code_information": [{"code": "95783", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLYSOM ANY AGE 1-3> PARAM", "code_information": [{"code": "95808", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLYSPORIN (BACIT Z/POLY B) OINT PKT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000368", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POLYSPORIN POWDER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000592", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POLYVALENT MULT ORG EA AG IA", "code_information": [{"code": "87451", "type": "CPT"}], "standard_charges": [{"minimum": 12.09, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PONTIC PORCELAIN TO TITANIUM", "code_information": [{"code": "D6243", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PONTIC TITANIUM", "code_information": [{"code": "D6214", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PONTIC-INDIRECT RESIN BASED", "code_information": [{"code": "D6205", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POOLING BLOOD PLATELETS", "code_information": [{"code": "86965", "type": "CPT"}], "standard_charges": [{"minimum": 33.57, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORC/CERAM INLAY >= 3 SURFAC", "code_information": [{"code": "D6601", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORCELAIN/CERAMIC INLAY 2SRF", "code_information": [{"code": "D6600", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORCELAIN/CERAMIC RETAINER", "code_information": [{"code": "D6548", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORCINE IMPLANT, PERMACOL", "code_information": [{"code": "C9364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORFIMER SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORPHYRINS 24HR UR", "code_information": [{"code": "84120", "type": "CPT"}, {"code": "1000098", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.92, "maximum": 78.35, "gross_charge": 87.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORPHYRINS QUANT, RDM URINE", "code_information": [{"code": "84120", "type": "CPT"}, {"code": "1000856", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.92, "maximum": 78.35, "gross_charge": 87.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 78.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORT, INDWELLING, IMP", "code_information": [{"code": "C1788", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORTABLE HOME SUCTION PUMP", "code_information": [{"code": "K0743", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORTABLE PEAK FLOW METER", "code_information": [{"code": "S8096", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POS AIRWAY PRESS PRESCRIBED", "code_information": [{"code": "G8845", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POS CLIN DEPRES SCRN F/U DOC", "code_information": [{"code": "G8431", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POS MACROALBUMINURIA REV", "code_information": [{"code": "3062F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POS MICROALBUMINURIA REV", "code_information": [{"code": "3060F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSEY PALM GRIPS", "code_information": [{"code": "3001233", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POSITION SEAT SPEC ORTH NEED", "code_information": [{"code": "T5001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSITIONAL CHANGE OF FINGER", "code_information": [{"code": "26555", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92532", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92542", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSITIONING CUSHION", "code_information": [{"code": "E0190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST 1 SRFC RESINBASED CMPST", "code_information": [{"code": "D2391", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST 2 SRFC RESINBASED CMPST", "code_information": [{"code": "D2392", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST 3 SRFC RESINBASED CMPST", "code_information": [{"code": "D2393", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST >=4SRFC RESINBASE CMPST", "code_information": [{"code": "D2394", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST AND CORE CAST + CROWN", "code_information": [{"code": "D2952", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST D/C H VST NEW PT 20 M", "code_information": [{"code": "G2001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST OP SERVICE LVRS MIN 6", "code_information": [{"code": "G0305", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST REMOVAL", "code_information": [{"code": "D2955", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST VERT ARTHRPLST 1 LUMBAR", "code_information": [{"code": "202T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-COITAL MUCOUS EXAM", "code_information": [{"code": "Q0115", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 30M", "code_information": [{"code": "G2014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 60M", "code_information": [{"code": "G2015", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 20 M", "code_information": [{"code": "G2006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 30 M", "code_information": [{"code": "G2007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 45 M", "code_information": [{"code": "G2008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 60 M", "code_information": [{"code": "G2009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 75 M", "code_information": [{"code": "G2013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 30 M", "code_information": [{"code": "G2002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 45 M", "code_information": [{"code": "G2003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 60 M", "code_information": [{"code": "G2004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 75 M", "code_information": [{"code": "G2005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSTERIOR GAIT TRAINER", "code_information": [{"code": "E8000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSTOP FOLLOW-UP VISIT", "code_information": [{"code": "99024", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSTOP REN FAIL", "code_information": [{"code": "G8575", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [{"code": "862", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [{"code": "863", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "857", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "856", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "858", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [{"code": "769", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES", "code_information": [{"code": "776", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "POSTPARTUM CARE VISIT", "code_information": [{"code": "503F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSTSURGICAL OBTURATOR", "code_information": [{"code": "D5932", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POTASSIUM -URINE-RDM", "code_information": [{"code": "84133", "type": "CPT"}, {"code": "1000656", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.44, "maximum": 22.92, "gross_charge": 25.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM 24HR UR", "code_information": [{"code": "84133", "type": "CPT"}, {"code": "1000099", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.44, "maximum": 22.92, "gross_charge": 25.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM BICARB EFFERVESCENT 20MEQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001160", "type": "CDM"}, {"code": "51801001230", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM BICARB EFFERVESCENT 25MEQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000745", "type": "CDM"}, {"code": "51801000130", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM CHL 20MEQ/1000ML 0.45% NS IV", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000997", "type": "CDM"}, {"code": "00409925739", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHL 20MEQ/1000ML 0.9% NS IV", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "7000370", "type": "CDM"}, {"code": "00409711509", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHL 20MEQ/1000ML D5 .45% NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000763", "type": "CDM"}, {"code": "00409790209", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHL 20MEQ/1000ML D5/0.45% NS", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000737", "type": "CDM"}, {"code": "00338067104", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHL 30MEQ/1000ML 0.45% NS IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000827", "type": "CDM"}, {"code": "00409665305", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHL 40MEQ/1000ML 0.9% NS IV", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000925", "type": "CDM"}, {"code": "00409665305", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHL 40MEQ/1000ML D5 .45% NS", "drug_information": {"unit": 30.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000674", "type": "CDM"}, {"code": "63323096730", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHL 40MEQ/100ML WATER", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000955", "type": "CDM"}, {"code": "00338070348", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHL ER (KLOR-CON) CAP 10MEQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000369", "type": "CDM"}, {"code": "70010014801", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM CHL LIQUID 10% 20MEQ/15ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000993", "type": "CDM"}, {"code": "72888004113", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM CHLORIDE 20MEQ INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "72000789", "type": "CDM"}, {"code": "00409665106", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM ER (KLOR-CON) CAP 8MEQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000234", "type": "CDM"}, {"code": "66758011013", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM ER (KLOR-CON) TAB 10MEQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004317", "type": "CDM"}, {"code": "31722013001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM ER (KLOR-CON) TAB 20MEQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000314", "type": "CDM"}, {"code": "00832532511", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM GLUCONATE 595MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000688", "type": "CDM"}, {"code": "43072000484", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM HYDROXIDE PREPS", "code_information": [{"code": "Q0112", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POTASSIUM PHOSPHATE 15MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200052", "type": "CDM"}, {"code": "00409729501", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POTASSIUM SERUM", "code_information": [{"code": "84132", "type": "CPT"}, {"code": "1000193", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.47, "maximum": 24.46, "gross_charge": 27.18, "discounted_cash": 54.17, "estimated_discounted_cash": 27.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 24.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTENT ANTIVIR THXPY RXD", "code_information": [{"code": "4276F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POVIDONE-IODINE SEPP", "code_information": [{"code": "3000531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POW MOBIL DEV NO DMEPDAC", "code_information": [{"code": "K0899", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POWER BONE MARROW BX NEEDLE", "code_information": [{"code": "C1830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POWER OPERATED VEHICLE NOC", "code_information": [{"code": "K0812", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POWER WHEELCHAIR NOC", "code_information": [{"code": "K0898", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POWERED W/C CUSHION", "code_information": [{"code": "E2610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POWERSOUTH FLU VACCINE INJ 0.5 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001026", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "POWERSOUTH LAB CHARGE", "code_information": [{"code": "1000996", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PP EVAL/EDU NOT PERF", "code_information": [{"code": "G9358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PP EVAL/EDU PERF", "code_information": [{"code": "G9357", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PPP2R2B GEN DETC ABNOR ALLEL", "code_information": [{"code": "81343", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PPPS, INITIAL VISIT", "code_information": [{"code": "G0438", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PPPS, SUBSEQ VISIT", "code_information": [{"code": "G0439", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRALATREXATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9307", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRALIDOXIME CHLORIDE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2730", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRANDIN (REPAGLINIDE) 2MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001999", "type": "CDM"}, {"code": "57237015901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRAVACHOL (PRAVASTATIN) 10MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001740", "type": "CDM"}, {"code": "84386003190", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRAVACHOL (PRAVASTATIN) 20MG TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001041", "type": "CDM"}, {"code": "00904589261", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRAVACHOL (PRAVASTATIN) TAB 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000371", "type": "CDM"}, {"code": "00904589361", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRCRD DRG 0-5YR OR W/ANOMLY", "code_information": [{"code": "33018", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 6YR+ W/O CGEN CAR", "code_information": [{"code": "33017", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-HTN OR HTN DOC, F/U INDC", "code_information": [{"code": "G8950", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-HTN OR HTN DOC, F/U INDC", "code_information": [{"code": "M1278", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-HTN/HTN, NO F/U, NOT GVN", "code_information": [{"code": "G8952", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-HTN/HTN, NO F/U, NOT GVN", "code_information": [{"code": "M1279", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS 1-9 DOS", "code_information": [{"code": "G0304", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS 10-15DOS", "code_information": [{"code": "G0303", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS COMPLETE", "code_information": [{"code": "G0302", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-PLAN 3D MODEL W/CCTA", "code_information": [{"code": "C9793", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-PRXD RSK ET AL DOCD", "code_information": [{"code": "3018F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-SURG EYE MEASURES DOCD", "code_information": [{"code": "3073F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-VISIT PATIENT SCREENING", "code_information": [{"code": "D9912", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREALBUMIN", "code_information": [{"code": "84134", "type": "CPT"}, {"code": "1000228", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.78, "maximum": 77.7, "gross_charge": 86.34, "discounted_cash": 54.17, "estimated_discounted_cash": 86.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 69.07, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRECISION ATTACHMENT", "code_information": [{"code": "D5862", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRECISION ATTACHMENT", "code_information": [{"code": "D6950", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRED<=5 MG RA GLU <6M", "code_information": [{"code": "G2112", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRED>5 MG >6M, NO CHG DA", "code_information": [{"code": "G2113", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREDNISOLONE ACETATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREDNISOLONE ACETATE OPTH SUSP 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000301", "type": "CDM"}, {"code": "61314063710", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 86.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREDNISOLONE SOLUTION 5MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000501", "type": "CDM"}, {"code": "50383004004", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREDNISONE 1MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7512", "type": "HCPCS"}, {"code": "7004507", "type": "CDM"}, {"code": "59651048401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREDNISONE TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7512", "type": "HCPCS"}, {"code": "7001085", "type": "CDM"}, {"code": "00603533832", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREDNISONE TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7512", "type": "HCPCS"}, {"code": "7000375", "type": "CDM"}, {"code": "60687014501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREDNISONE TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7512", "type": "HCPCS"}, {"code": "7000376", "type": "CDM"}, {"code": "60687012201", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREFAB PORC/CER CROWN PERM", "code_information": [{"code": "D2928", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREFAB PORC/CERAM CROWN PRI", "code_information": [{"code": "D2929", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREFAB POST/CORE + CROWN", "code_information": [{"code": "D2954", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREFAB STAINLESS STEEL CROWN", "code_information": [{"code": "D2933", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREFAB STEEL CROWN PRIMARY", "code_information": [{"code": "D2934", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREFAB STNLSS STEEL CROWN PE", "code_information": [{"code": "D2931", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREFAB STNLSS STEEL CRWN PRI", "code_information": [{"code": "D2930", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREFABRICATED ABUTMENT", "code_information": [{"code": "D6056", "type": "HCPCS"}], "standard_charges": [{"minimum": 4581.79, "maximum": 4581.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4581.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREFABRICATED RESIN CROWN", "code_information": [{"code": "D2932", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREG DRNG ADJV TRTMT", "code_information": [{"code": "G2205", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREGNENOLONE", "code_information": [{"code": "84140", "type": "CPT"}, {"code": "1000365", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 23.77, "maximum": 110.16, "gross_charge": 122.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 97.92, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 110.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 69.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREMARIN (ESTROGEN CONJ) TAB 0.3 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000719", "type": "CDM"}, {"code": "00046110081", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREMARIN (ESTROGEN CONJ) TAB 0.625MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000377", "type": "CDM"}, {"code": "00046110281", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [{"code": "792", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PRENATAL AT RISK EDUCATION", "code_information": [{"code": "H1003", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRENATAL CARE ATRISK ASSESSM", "code_information": [{"code": "H1000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRENATAL FLOW SHEET", "code_information": [{"code": "501F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRENATAL INFECT DIS AB", "code_information": [{"code": "86645", "type": "CPT"}, {"code": "1000031", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.38, "maximum": 418.5, "gross_charge": 465.0, "discounted_cash": 54.17, "estimated_discounted_cash": 99.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 372.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 418.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 265.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRENATAL VITAMINS 30 DAY", "code_information": [{"code": "S0197", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRENATAL/IRON VITAMIN TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000175", "type": "CDM"}, {"code": "44946104509", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRENATALCARE ENHANCED SRV PK", "code_information": [{"code": "H1005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREOP ASSES 4 CATARACT SURG", "code_information": [{"code": "3325F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREORTHODONTIC TX VISIT", "code_information": [{"code": "D8660", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP & CANNULJ CDVR DON LUNG", "code_information": [{"code": "494T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP CADAVER RENAL ALLOGRAFT", "code_information": [{"code": "50323", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP CORNEAL ENDO ALLOGRAFT", "code_information": [{"code": "65757", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/ARTERY", "code_information": [{"code": "44721", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/VENOUS", "code_information": [{"code": "44720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER 3-SEGMENT", "code_information": [{"code": "47144", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER LOBE SPLIT", "code_information": [{"code": "47145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER WHOLE", "code_information": [{"code": "47143", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/ARTERIAL", "code_information": [{"code": "47147", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/VENOUS", "code_information": [{"code": "47146", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS", "code_information": [{"code": "48551", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS/VENOUS", "code_information": [{"code": "48552", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR RENAL GRAFT", "code_information": [{"code": "50325", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/ARTERIAL", "code_information": [{"code": "50328", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/URETERAL", "code_information": [{"code": "50329", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/VENOUS", "code_information": [{"code": "50327", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP TUM CAV IORT PRIM CRNOT", "code_information": [{"code": "735T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARATION FOR BLADDER XRAY", "code_information": [{"code": "51605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARATION H (NF-Preparation H) SUPP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002631", "type": "CDM"}, {"code": "00113027953", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREPARATION OF REPORT", "code_information": [{"code": "90889", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARATION PALATE MOLD", "code_information": [{"code": "42280", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART", "code_information": [{"code": "33944", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART/LUNG", "code_information": [{"code": "33933", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR INTESTINE", "code_information": [{"code": "44715", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG DOUBLE", "code_information": [{"code": "32856", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG SINGLE", "code_information": [{"code": "32855", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE EMBRYO FOR TRANSFER", "code_information": [{"code": "89255", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 307.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 307.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21076", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21077", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21079", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21080", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21081", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21082", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21083", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21084", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21085", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21086", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21087", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21088", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE FECAL MICROBIOTA", "code_information": [{"code": "44705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE HEART-AORTA CONDUIT", "code_information": [{"code": "33404", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE PENIS STUDY", "code_information": [{"code": "54230", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE SPERM DUCT X-RAY", "code_information": [{"code": "55300", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPJ TUM CAV IORT PRTL MAST", "code_information": [{"code": "19294", "type": "CPT"}], "standard_charges": [{"minimum": 21736.36, "maximum": 21736.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 21736.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPUTIAL STRETCHING", "code_information": [{"code": "54450", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRES ANTIBX ON/WITHIN 3 DAY", "code_information": [{"code": "G8711", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRES DIG COG BEHAV THERA FDA", "code_information": [{"code": "A9291", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRES DIG VISUAL THERAPY FDA", "code_information": [{"code": "A9292", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRES/ABSN HMRHG/LESION DOCD", "code_information": [{"code": "3110F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRES/ABSN URINE INCON ASSESS", "code_information": [{"code": "1090F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRESBYOPIA-CORRECT FUNCTION", "code_information": [{"code": "V2788", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRESC ANTICO MED IN PP", "code_information": [{"code": "M1056", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRESCRIPTION DRUG, GENERIC", "code_information": [{"code": "S5000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRESCRIPTION DRUG,BRAND NAME", "code_information": [{"code": "S5001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRESERVISION AREDS 2 SOFT GELS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003280", "type": "CDM"}, {"code": "24208069762", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRESSURE TREATMENT ESOPHAGUS", "code_information": [{"code": "43460", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV CARDREHAB QUALCARDEVENT", "code_information": [{"code": "4510F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 15", "code_information": [{"code": "99401", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 30", "code_information": [{"code": "99402", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 45", "code_information": [{"code": "99403", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 60", "code_information": [{"code": "99404", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV RESIN REST, PERM TOOTH", "code_information": [{"code": "D1352", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV TRT INF D/O HIV/HEP MVP", "code_information": [{"code": "M1368", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 1-4", "code_information": [{"code": "99392", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 12-17", "code_information": [{"code": "99394", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 18-39", "code_information": [{"code": "99395", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 40-64", "code_information": [{"code": "99396", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 5-11", "code_information": [{"code": "99393", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 12-17", "code_information": [{"code": "99384", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 18-39", "code_information": [{"code": "99385", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 40-64", "code_information": [{"code": "99386", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 5-11", "code_information": [{"code": "99383", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREVACID CAP DR 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "95", "type": "CDM"}, {"code": "00378803093", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREVACID DR (LANSOPRAZOLE DR) CAP 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000923", "type": "CDM"}, {"code": "70756080630", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREVACID SOLUTAB DR 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000202", "type": "CDM"}, {"code": "64764054411", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 57.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREVAIL INSERTS", "code_information": [{"code": "3000267", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 33.92, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99411", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99412", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE MEDICINE SS", "code_information": [{"code": "G4029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRFRMNC DOCD 2 WKS B/4 SURG", "code_information": [{"code": "3328F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL ICDS SS IP", "code_information": [{"code": "575T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IIMS IP", "code_information": [{"code": "528T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IMPLTBL SYS", "code_information": [{"code": "93260", "type": "CPT"}], "standard_charges": [{"minimum": 467.66, "maximum": 467.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 467.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL ISDSS IP", "code_information": [{"code": "683T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL PM/LDLS PM", "code_information": [{"code": "93279", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS IP", "code_information": [{"code": "93285", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS REMOTE", "code_information": [{"code": "650T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL WCS IP", "code_information": [{"code": "522T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL CARDIAC MODULJ", "code_information": [{"code": "417T", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93282", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93283", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93284", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 1CHMBR IP", "code_information": [{"code": "826T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 2CHMBR IP", "code_information": [{"code": "804T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG IO RTA ELTRD RA", "code_information": [{"code": "472T", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRILOSEC (OMEPRAZOLE) DR CAP 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000402", "type": "CDM"}, {"code": "00904691761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC 1ST VSL", "code_information": [{"code": "37184", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC SBSQ VSL", "code_information": [{"code": "37185", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIMARY CLOSURE SINUS PERF", "code_information": [{"code": "D7261", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX", "code_information": [{"code": "Q4110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIMAXIN (IMIPENEM) 500MG INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0743", "type": "HCPCS"}, {"code": "7000380", "type": "CDM"}, {"code": "00006351659", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 36.3, "maximum": 57.33, "gross_charge": 63.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMAXIN 500MG/100ML 0.9% NS", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0743", "type": "HCPCS"}, {"code": "72000800", "type": "CDM"}, {"code": "00006351659", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 36.3, "maximum": 57.33, "gross_charge": 63.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99424", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF 1ST 30", "code_information": [{"code": "99426", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF EA ADDL", "code_information": [{"code": "99427", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS", "code_information": [{"code": "998", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PRINIVIL (LISINOPRIL) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000290", "type": "CDM"}, {"code": "00904679861", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRINIVIL (LISINOPRIL) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000447", "type": "CDM"}, {"code": "60687065621", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRINIVIL (LISINOPRIL) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000488", "type": "CDM"}, {"code": "60687033301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRINIVIL (LISINOPRIL) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001008", "type": "CDM"}, {"code": "00904679761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRINIVIL (NF-LISINOPRIL) 30MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001680", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRIOR DX/ACTIVE CLIN ASCVD", "code_information": [{"code": "G9662", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIOR HISTORY OF KNOWN CVD", "code_information": [{"code": "M1256", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIOR THYROID DISE DX", "code_information": [{"code": "G9553", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRISTIQ 50MG ORAL TABLET, EXTENDED RE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000875", "type": "CDM"}, {"code": "00008121130", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRIVATE DUTY/INDEPENDENT NSG", "code_information": [{"code": "T1000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRKNS DIAG RVIEWED", "code_information": [{"code": "1400F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRO NET SIZE 2", "code_information": [{"code": "3001194", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRO NET SZ 3", "code_information": [{"code": "3001288", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRO NET SZ 4 ELASTIC NET", "code_information": [{"code": "3001195", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRO NET SZ 5 ELASTIC NET", "code_information": [{"code": "3001196", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRO NET SZ 7 ELASTIC NET", "code_information": [{"code": "3001203", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRO NET SZ 9 ELASTIC NET", "code_information": [{"code": "3001198", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRO-STAT 64", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3001191", "type": "CDM"}, {"code": "26974041007", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRO-STAT SUGAR FREE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000933", "type": "CDM"}, {"code": "26974041007", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROAIR (ALBUTEROL) MDI 90MCG INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200061", "type": "CDM"}, {"code": "00173068224", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 92.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROAMATINE (MIDODRINE HCL) 10MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000341", "type": "CDM"}, {"code": "00245021311", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROAMATINE (MIDODRINE HCL) 5MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002285", "type": "CDM"}, {"code": "00904681861", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROAMATINE (MIDODRINE HCL) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000764", "type": "CDM"}, {"code": "00904681761", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68810", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68811", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68815", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBE NL DUCT W/BALLOON", "code_information": [{"code": "68816", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBE, PERC LUMB DISC", "code_information": [{"code": "C2614", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBE, ROBOTIC, WATER-JET", "code_information": [{"code": "C2596", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBE/NEEDLE, CRYO", "code_information": [{"code": "C2618", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBIOTIC FORMULA CAP 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002141", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROCAINAMIDE", "code_information": [{"code": "80192", "type": "CPT"}, {"code": "1000194", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 19.26, "maximum": 89.23, "gross_charge": 99.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCAINAMIDE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2690", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCALCITONIN (PCT)", "code_information": [{"code": "84145", "type": "CPT"}], "standard_charges": [{"minimum": 31.3, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCARBAZINE, ORAL", "code_information": [{"code": "S0182", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCARDIA (NIFEDIPINE) 10MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001837", "type": "CDM"}, {"code": "00904722961", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROCARDIA XL ( NIFEDIPINE ER) 60MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001094", "type": "CDM"}, {"code": "50742026101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROCARDIA XL (NIFEDIPINE ER) TAB 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000383", "type": "CDM"}, {"code": "50742026003", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROCARE WIPES ADULT", "code_information": [{"code": "3000263", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROCESSING FEE", "code_information": [{"code": "1400005", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 5 MG", "code_information": [{"code": "S0183", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCRIT (EPOETIN ALFA) 2000U/ML INJ.", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0885", "type": "HCPCS"}, {"code": "72004309", "type": "CDM"}, {"code": "59676030201", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 88.31, "maximum": 1147.21, "gross_charge": 154.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 123.95, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 139.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 88.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTO-MED HC 2.5% CREAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004304", "type": "CDM"}, {"code": "69315031228", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 24.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROCTOFOAM HC (PRAMOXINE) 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000388", "type": "CDM"}, {"code": "00037682315", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 320.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY ABLATE", "code_information": [{"code": "45320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY BLEED", "code_information": [{"code": "45317", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DILATE", "code_information": [{"code": "45303", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DX", "code_information": [{"code": "45300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY FB", "code_information": [{"code": "45307", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45308", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45309", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45315", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY VOLVUL", "code_information": [{"code": "45321", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/BX", "code_information": [{"code": "45305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/STENT", "code_information": [{"code": "45327", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCURE DONOR SPERM", "code_information": [{"code": "S4026", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCUREN OR OTHER GROWTH FAC", "code_information": [{"code": "S9055", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROGENAMATRIX, PER SQ CM", "code_information": [{"code": "Q4222", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE LEVEL", "code_information": [{"code": "84144", "type": "CPT"}, {"code": "1000065", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 23.99, "maximum": 111.13, "gross_charge": 123.48, "discounted_cash": 54.17, "estimated_discounted_cash": 123.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 98.78, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 111.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 70.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGRAF (TACROLIMUS) 0.5MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7507", "type": "HCPCS"}, {"code": "7004356", "type": "CDM"}, {"code": "70377001411", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGRAF BIOCARB", "code_information": [{"code": "80197", "type": "CPT"}, {"code": "1000202", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.79, "maximum": 193.5, "gross_charge": 215.0, "discounted_cash": 54.17, "estimated_discounted_cash": 225.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 172.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 193.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 122.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGRAM INTAKE ASSESSMENT", "code_information": [{"code": "T1023", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.86, "maximum": 76.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROGRAMABLE INGEST CAPSULE", "code_information": [{"code": "A9269", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROGRAMMER ORALLY INGEST CAP", "code_information": [{"code": "A9268", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROGRESSIVE LENS PER LENS", "code_information": [{"code": "V2781", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROINSULIN", "code_information": [{"code": "84206", "type": "CPT"}, {"code": "1000480", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 30.69, "maximum": 103.37, "gross_charge": 105.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.36, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 94.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROL INTUBATION REQ", "code_information": [{"code": "G8569", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLACTIN", "code_information": [{"code": "84146", "type": "CPT"}, {"code": "1000223", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 22.29, "maximum": 103.37, "gross_charge": 114.72, "discounted_cash": 54.17, "estimated_discounted_cash": 114.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 91.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG CLIN STAFF SVC 1ST HR", "code_information": [{"code": "99415", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLNG CLIN STAFF SVC EA ADD", "code_information": [{"code": "99416", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLNG IP/OBS E/M EA 15 MIN", "code_information": [{"code": "99418", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLNG OP E/M EACH 15 MIN", "code_information": [{"code": "99417", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG HOME EVAL ADD 15M", "code_information": [{"code": "G0318", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG INPT EVAL ADD15 M", "code_information": [{"code": "G0316", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG NURSIN FAC EVAL 15M", "code_information": [{"code": "G0317", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG OUTPT/OFFICE VIS", "code_information": [{"code": "G2212", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG PREV SVCS, ADDL 30M", "code_information": [{"code": "G0514", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG PREV SVCS, FIRST 30M", "code_information": [{"code": "G0513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG SERV W/O CONTACT ADD", "code_information": [{"code": "99359", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG SERVICE W/O CONTACT", "code_information": [{"code": "99358", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONGED IV INF, REQ PUMP", "code_information": [{"code": "C8957", "type": "HCPCS"}], "standard_charges": [{"minimum": 1636.8, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLOTHERAPY", "code_information": [{"code": "M0076", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROMAZINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2950", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE DM SYR 15MG-6.25MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001158", "type": "CDM"}, {"code": "70436015542", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROMETHAZINE HCL 12.5MG ORAL", "code_information": [{"code": "Q0169", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROMISE CREAM", "code_information": [{"code": "3000266", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROMISE PADS YELLOW", "code_information": [{"code": "3000268", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 44.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROPARACAINE HCL OPTH 0.5% GTTS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000927", "type": "CDM"}, {"code": "70069060101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT CRTX DTHRM", "code_information": [{"code": "67141", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT PC", "code_information": [{"code": "67145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROPYLTHIOURACIL TABLET 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001067", "type": "CDM"}, {"code": "00480924201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROS, URINARY SPH, IMP", "code_information": [{"code": "C1815", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSCAR (FINASTERIDE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000309", "type": "CDM"}, {"code": "65862014930", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROST CNCR RSK NOT LW/MD/HGH", "code_information": [{"code": "3274F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTATE BIOPSY, ANY MTHD", "code_information": [{"code": "G0416", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.12, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTATE CA SCREENING; DRE", "code_information": [{"code": "G0102", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTATE LASER ENUCLEATION", "code_information": [{"code": "52649", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTATE SATURATION SAMPLING", "code_information": [{"code": "55706", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY (TURP)", "code_information": [{"code": "52601", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH CC", "code_information": [{"code": "666", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH MCC", "code_information": [{"code": "665", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "667", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PROSTATIC ACID PHOSPHATASE", "code_information": [{"code": "84066", "type": "CPT"}, {"code": "1000246", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.11, "maximum": 51.46, "gross_charge": 57.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 45.74, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 51.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATIC MICROWAVE THERMOTX", "code_information": [{"code": "53850", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTATIC RF THERMOTX", "code_information": [{"code": "53852", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTH RETINA RECEIVE&GEN", "code_information": [{"code": "100T", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS MODIFICATION", "code_information": [{"code": "D5875", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS, BREAST, IMP", "code_information": [{"code": "C1789", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS, PENILE, INFLATAB", "code_information": [{"code": "C1813", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS, PENILE, NON-INF", "code_information": [{"code": "C2622", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHETIC DEVICE REPAIR REP", "code_information": [{"code": "L7510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHETIC DONNING SLEEVE", "code_information": [{"code": "L7600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHETIC EYE OTHER TYPE", "code_information": [{"code": "V2629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHETIC IMPLANT NOS", "code_information": [{"code": "L8699", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHETIC TRAING 1ST ENC", "code_information": [{"code": "97761", "type": "CPT"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTHODONT HIGH NOBLE METAL", "code_information": [{"code": "D6210", "type": "HCPCS"}], "standard_charges": [{"minimum": 1229.99, "maximum": 1229.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1229.99, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTAMINE SULFATE 10MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2720", "type": "HCPCS"}, {"code": "7000398", "type": "CDM"}, {"code": "63323022905", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.17, "maximum": 14.49, "gross_charge": 16.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 9.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTAMINE SULFATE PER 50 MG", "code_information": [{"code": "A4802", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTECTIVE RESTORATION", "code_information": [{"code": "D2940", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTEIN ANALYSIS W/PROBE", "code_information": [{"code": "88372", "type": "CPT"}], "standard_charges": [{"minimum": 30.15, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTEIN C ANTIGEN", "code_information": [{"code": "85302", "type": "CPT"}, {"code": "1000504", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 13.81, "maximum": 64.04, "gross_charge": 71.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN C CONCENTRATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2724", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELECTROPHORESIS 24HR UR", "code_information": [{"code": "84165", "type": "CPT"}, {"code": "1000248", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.35, "maximum": 57.21, "gross_charge": 63.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELECTROPHORESIS URINE RANDOM", "code_information": [{"code": "84166", "type": "CPT"}, {"code": "1000467", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.5, "maximum": 99.0, "gross_charge": 110.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN S ANTIGEN", "code_information": [{"code": "85305", "type": "CPT"}, {"code": "1000512", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.35, "maximum": 61.77, "gross_charge": 68.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.91, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 39.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN WESTERN BLOT TEST", "code_information": [{"code": "84182", "type": "CPT"}], "standard_charges": [{"minimum": 33.59, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTEIN WESTERN BLOT TISSUE", "code_information": [{"code": "88371", "type": "CPT"}], "standard_charges": [{"minimum": 25.56, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTEIN, TOTAL, QUANT, 24HR UR", "code_information": [{"code": "84155", "type": "CPT"}, {"code": "1000021", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.22, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "estimated_discounted_cash": 21.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN/CREA RATIO URINE RDM", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "1000535", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.96, "maximum": 27.56, "gross_charge": 30.63, "discounted_cash": 54.17, "estimated_discounted_cash": 23.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTHROMBIN COMPLEX KCENTRA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTHROMBIN FACTOR II (PROTHROMBIN)", "code_information": [{"code": "81240", "type": "CPT"}, {"code": "1000537", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 75.54, "maximum": 241.3, "gross_charge": 268.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 75.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 214.49, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 241.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 152.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTHROMBIN TEST", "code_information": [{"code": "85611", "type": "CPT"}], "standard_charges": [{"minimum": 4.53, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTIME", "code_information": [{"code": "85610", "type": "CPT"}, {"code": "1000087", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.93, "maximum": 20.92, "gross_charge": 23.25, "discounted_cash": 54.17, "estimated_discounted_cash": 23.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 20.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TREATMENT COMPLEX", "code_information": [{"code": "77525", "type": "CPT"}], "standard_charges": [{"minimum": 1786.58, "maximum": 4601.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1786.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4601.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT INTERMEDIATE", "code_information": [{"code": "77523", "type": "CPT"}], "standard_charges": [{"minimum": 1614.88, "maximum": 4601.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1614.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4601.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/COMP", "code_information": [{"code": "77522", "type": "CPT"}], "standard_charges": [{"minimum": 1390.22, "maximum": 4601.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1390.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4601.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/O COMP", "code_information": [{"code": "77520", "type": "CPT"}], "standard_charges": [{"minimum": 1386.48, "maximum": 4601.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1386.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4601.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTONIX (PANTOPRAZOLE SOD) TAB DR 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001039", "type": "CDM"}, {"code": "60687072501", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROTONIX (PANTOPRAZOLE SOD) TAB DR 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000399", "type": "CDM"}, {"code": "00904647461", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROTONIX (PANTOPRAZOLE) 4MG/1ML SUSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004307", "type": "CDM"}, {"code": "65628002410", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 17.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROTONIX 40MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2470", "type": "HCPCS"}, {"code": "72001021", "type": "CDM"}, {"code": "31722020410", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 21.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTONIX 40MG/100ML NS IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000728", "type": "CDM"}, {"code": "31722020410", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROTOZOA ANTIBODY NOS", "code_information": [{"code": "86753", "type": "CPT"}], "standard_charges": [{"minimum": 14.25, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROVERA (medroxy-progest ace) tab: 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000631", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PROVIDE INR TEST MATER/EQUIP", "code_information": [{"code": "G0249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROZAC (FLUOXETINE) CAP 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000145", "type": "CDM"}, {"code": "00904734561", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT BLOCK >5 YR", "code_information": [{"code": "49507", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT REDUC >5 YR", "code_information": [{"code": "49505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRPERTL PEL PACK HEMRRG TRMA", "code_information": [{"code": "49013", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRT UXTR SEP ACS", "code_information": [{"code": "36837", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRTJ UXTR 1 ACS", "code_information": [{"code": "36836", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT 1 ART", "code_information": [{"code": "92924", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT ADDL", "code_information": [{"code": "92925", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC 1VSL", "code_information": [{"code": "92943", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC ADDL", "code_information": [{"code": "92944", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC MI 1 VSL", "code_information": [{"code": "92941", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT W/ANGIO 1 VSL", "code_information": [{"code": "92928", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT W/ANGIO ADDL", "code_information": [{"code": "92929", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92933", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92934", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIO ADDL ART", "code_information": [{"code": "92921", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIOPLAST 1 ART", "code_information": [{"code": "92920", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ CORONARY MECH THROMBECT", "code_information": [{"code": "92973", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ ELC NRV STIM CN WO IMPLT", "code_information": [{"code": "720T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ NJX BIOD OSTEO MATRL FEM", "code_information": [{"code": "814T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT 1 VSL", "code_information": [{"code": "92937", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT ADDL", "code_information": [{"code": "92938", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ TCAT THRM ABLT NRV P-ART", "code_information": [{"code": "793T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE OLECRN PROCESS", "code_information": [{"code": "24147", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE RADIAL H/N", "code_information": [{"code": "24145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRTL EXCHANGE TRANSFUSE NB", "code_information": [{"code": "36456", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSA (NON SCREENING)", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "1000276", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.15, "maximum": 97.98, "gross_charge": 108.87, "discounted_cash": 54.17, "estimated_discounted_cash": 112.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.09, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 97.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA (SCREENING)", "code_information": [{"code": "84152", "type": "CPT"}, {"code": "1000265", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.15, "maximum": 97.98, "gross_charge": 108.87, "discounted_cash": 54.17, "estimated_discounted_cash": 109.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.09, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 97.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA SCREENING", "code_information": [{"code": "G0103", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "estimated_discounted_cash": 108.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_percentage": 80.0, "possible_amount": 46.94, "count": "1 through 10", "median_amount": 46.94, "methodology": "percent of total billed charges", "10th_percentile": 46.94, "90th_percentile": 46.94}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 47.32, "count": "13", "median_amount": 44.64, "methodology": "percent of total billed charges", "10th_percentile": 44.64, "90th_percentile": 62.05}], "billing_class": "facility"}]}, {"description": "PSA/T/GLSC DOCD B/4 TXMNT", "code_information": [{"code": "3268F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSEUDOANEURYSM INJECTION TRT", "code_information": [{"code": "36002", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSEUDOEPHEDRINE TAB 30MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000400", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PSOR AS DOC NO SPC BM", "code_information": [{"code": "G9651", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSOR AS DOC SPC BM", "code_information": [{"code": "G9649", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PST VRT JT RPLCMT LMBR 1 SGM", "code_information": [{"code": "719T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSY DEP ANX AP AND ICD ASSE", "code_information": [{"code": "G2121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSY EVALUATION OF RECORDS", "code_information": [{"code": "90885", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSY/DEP/ANX/APANDICD NOASSE", "code_information": [{"code": "G2122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC ANXIETY DO MRNA 15 BMRK", "code_information": [{"code": "437U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 14 GENES", "code_information": [{"code": "173U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 15 GENES", "code_information": [{"code": "175U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC GENOM ALYS PNL 15 GEN", "code_information": [{"code": "345U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC GENOM ALYS PNL 15 GEN", "code_information": [{"code": "411U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC GENOMIC ALYS PNL 26 GEN", "code_information": [{"code": "423U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC MOOD DO MRNA 144 GENES", "code_information": [{"code": "291U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC STRS DO MRNA 72 GENES", "code_information": [{"code": "292U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYC SUICIDAL IDEA MRNA 54", "code_information": [{"code": "293U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCH DIAG EVAL W/MED SRVCS", "code_information": [{"code": "90792", "type": "CPT"}], "standard_charges": [{"minimum": 838.62, "maximum": 838.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 838.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCH DIAGNOSTIC EVALUATION", "code_information": [{"code": "90791", "type": "CPT"}], "standard_charges": [{"minimum": 838.62, "maximum": 838.62, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 838.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCH DISORDERS ASSESSED", "code_information": [{"code": "3700F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCH HLTH FAC SVC, PER DIEM", "code_information": [{"code": "H2013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCH SVCS PROVIDED", "code_information": [{"code": "4060F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCHOANALYSIS", "code_information": [{"code": "90845", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCHOED SVC, PER 15 MIN", "code_information": [{"code": "H2027", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCHOPHYSIOLOGICAL THERAPY", "code_information": [{"code": "90875", "type": "CPT"}], "standard_charges": [{"minimum": 510.0, "maximum": 510.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCHOPHYSIOLOGICAL THERAPY", "code_information": [{"code": "90876", "type": "CPT"}], "standard_charges": [{"minimum": 510.0, "maximum": 510.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCHOSES", "code_information": [{"code": "885", "type": "MS-DRG"}], "standard_charges": [{"minimum": 950.0, "maximum": 2160.69, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 950.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PSYCL TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCL TST EVAL PHYS/QHP EA", "code_information": [{"code": "96131", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TECH 1ST", "code_information": [{"code": "96138", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST AUTO RESULT", "code_information": [{"code": "96146", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST PHY/QHP 1ST", "code_information": [{"code": "96136", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST PHY/QHP EA", "code_information": [{"code": "96137", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST TECH EA", "code_information": [{"code": "96139", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYSOC REHAB SVC, PER 15 MIN", "code_information": [{"code": "H2017", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYSOC REHAB SVC, PER DIEM", "code_information": [{"code": "H2018", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX COMPLEX INTERACTIVE", "code_information": [{"code": "90785", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX CRISIS EA ADDL 30 MIN", "code_information": [{"code": "90840", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX CRISIS INITIAL 60 MIN", "code_information": [{"code": "90839", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 30 MINUTES", "code_information": [{"code": "90832", "type": "CPT"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 45 MINUTES", "code_information": [{"code": "90834", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 60 MINUTES", "code_information": [{"code": "90837", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 30 MIN", "code_information": [{"code": "90833", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 45 MIN", "code_information": [{"code": "90836", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 60 MIN", "code_information": [{"code": "90838", "type": "CPT"}], "standard_charges": [{"minimum": 466.51, "maximum": 466.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 466.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT + HCV ABY +VIR W/ RX 3 MO", "code_information": [{"code": "M1228", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 1 TDAP BETW 10-13 YRS", "code_information": [{"code": "G9416", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 1ST BIOLOG ANTIRHEUM", "code_information": [{"code": "G2182", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 45-85 W/ SCOPE", "code_information": [{"code": "G2204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 50 YRS W/CLIN IND HD", "code_information": [{"code": "G2188", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAIL INPT ADV ILL", "code_information": [{"code": "M1292", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND ADV ILL", "code_information": [{"code": "G2091", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND ADV ILL", "code_information": [{"code": "G2099", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND ADV ILL", "code_information": [{"code": "G2101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND ADV ILL", "code_information": [{"code": "G2107", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "G2090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "G2098", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "G2100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "G2106", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ FRAILTY AND MED DEM", "code_information": [{"code": "M1291", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G2081", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G2105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G9898", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G9901", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G9910", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "G9938", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66+ SNP OR LTC POS > 90D", "code_information": [{"code": "M1284", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66-80 FRAILTY AND ADV ILL", "code_information": [{"code": "G2116", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66-80 FRAILTY AND ADV ILL", "code_information": [{"code": "G2126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66-80 FRAILTY AND MED DEM", "code_information": [{"code": "G2115", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 66-80 FRAILTY AND MED DEM", "code_information": [{"code": "G2127", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 81+ FRAILTY", "code_information": [{"code": "G2118", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT 81+ FRAILTY", "code_information": [{"code": "G2125", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT >2 RSK FAC POST-OP VOMIT", "code_information": [{"code": "G9954", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT >= 86  W/ HI RISK", "code_information": [{"code": "G9661", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT AC STAT KID TRNSPLT WTLST", "code_information": [{"code": "M1268", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ALIVE", "code_information": [{"code": "G9787", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ALIVE 3 MOS POST PROC", "code_information": [{"code": "G9540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ANPHX DUE TO DTP BEF 13", "code_information": [{"code": "M1161", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ANPHX DUE TO HPV BEF 13", "code_information": [{"code": "M1163", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ANPHX DUE TO MENGB BEF 13", "code_information": [{"code": "M1160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ANPHX DUE TO PNEUM", "code_information": [{"code": "M1306", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ASKED RE SLEEP DISTURB", "code_information": [{"code": "4328F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ASKED RE SYMP AUTO DYSFXN", "code_information": [{"code": "4326F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ASKED/CNSLD AED EFFECTS", "code_information": [{"code": "6070F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ASST RE END LIFE ISSUES", "code_information": [{"code": "4553F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT BL SRG 30 DAY PST SRG", "code_information": [{"code": "G9625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT BSLN PAM, 2ND SCR 6-12 MO", "code_information": [{"code": "M1345", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT BWLI SRG 30 DAY PST SRG", "code_information": [{"code": "G9628", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT CARE ICU&VENT W/IN 24HRS", "code_information": [{"code": "4168F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT CAT AND THCK ON REPORT", "code_information": [{"code": "G9294", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT CAT/PN CAT/HIST GRD DOCD", "code_information": [{"code": "3260F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT CMPLT SUICD SAF PLN 120DY", "code_information": [{"code": "M1351", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT COMORB DX 12M OF EPI", "code_information": [{"code": "G2175", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT CONSID POSS RISK FX", "code_information": [{"code": "3572F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT CONTRAST BATH", "code_information": [{"code": "4000047", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 49.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT COPD SYMPTOMS", "code_information": [{"code": "M1218", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT COUNS 4 TXMNT OPT PROST", "code_information": [{"code": "4163F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT COUNSLD ON EXAM FOR MOLES", "code_information": [{"code": "5005F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT CR FT INF LM OR PT ID SL", "code_information": [{"code": "M1041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT CURRENTLY ON STATIN", "code_information": [{"code": "G9797", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT Caregiver training 1st 30 min", "code_information": [{"code": "97550", "type": "CPT"}, {"code": "4000218", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"minimum": 107.57, "maximum": 169.85, "gross_charge": 188.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 141.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 150.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 169.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 107.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT Caregiver training ea addl 15", "code_information": [{"code": "97551", "type": "CPT"}, {"code": "4000220", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"minimum": 52.13, "maximum": 82.32, "gross_charge": 91.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 68.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 73.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 82.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 52.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DEBRIDEMENT WHIRLPOOL", "code_information": [{"code": "4000006", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 506.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT DIABETIC FOOT ASESS", "code_information": [{"code": "4000007", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 106.32, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT DIED DUR MEAS PD", "code_information": [{"code": "M1356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DIED DUR MEAS PD", "code_information": [{"code": "M1362", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DIED DURING INPT/30D AFT", "code_information": [{"code": "G9812", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DIED FROM CANCER", "code_information": [{"code": "G9846", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DIED FROM CANCER", "code_information": [{"code": "G9859", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DIED IN PP", "code_information": [{"code": "M1060", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DISCH HOME DAY #2 CEA", "code_information": [{"code": "G8834", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DISCH HOME DAY #2 EVAR", "code_information": [{"code": "G8826", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC", "code_information": [{"code": "G9531", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC NO BURN PRIOR TO D/C", "code_information": [{"code": "G8909", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC NO EVENTS ON DISCHARG", "code_information": [{"code": "G8907", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC NO FALL IN ASC", "code_information": [{"code": "G8911", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC NO WRONG EVENT", "code_information": [{"code": "G8913", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC TO HAVE FALL IN ASC", "code_information": [{"code": "G8910", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC W BURN PRIOR TO D/C", "code_information": [{"code": "G8908", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC WITH WRONG EVENT", "code_information": [{"code": "G8912", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DRESSING CHANGE ONLY WITH 97602 (PT)", "code_information": [{"code": "99211", "type": "CPT"}, {"code": "4000008", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"minimum": 14.97, "maximum": 23.65, "gross_charge": 26.28, "discounted_cash": 54.17, "estimated_discounted_cash": 155.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT DX HST CR PT SK LG CR SCR", "code_information": [{"code": "M1018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DX LUM IDI OR CONG SCOL", "code_information": [{"code": "M1040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DX LUM SP REG CACR", "code_information": [{"code": "M1037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DX LUM SP REG FRACT", "code_information": [{"code": "M1038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DX LUM SP REG INF", "code_information": [{"code": "M1039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DX MEOP OR SUR STERI", "code_information": [{"code": "M1016", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT E-STIM CONSTANT ATTENDANCE", "code_information": [{"code": "4000009", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 52.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT E-STIM UNATTENDED NOT WOUNDS", "code_information": [{"code": "4000010", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 41.67, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT E-STIM WOUND", "code_information": [{"code": "4000011", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 41.67, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT ED POS 23", "code_information": [{"code": "G0035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ED RE COMP THXPY RCVD", "code_information": [{"code": "4268F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ED RE FT CARE INSPCT RCVD", "code_information": [{"code": "4305F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ED WRITE/ORAL PTS W/ HF", "code_information": [{"code": "4003F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EDU RE ALCOH DRNKNG DONE", "code_information": [{"code": "4158F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EDUCATION NOC GROUP", "code_information": [{"code": "S9446", "type": "HCPCS"}], "standard_charges": [{"minimum": 146.67, "maximum": 146.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 146.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EDUCATION NOC INDIVID", "code_information": [{"code": "S9445", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ENCEPH DUE TO DTP BEF 13", "code_information": [{"code": "M1162", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ENROLL HOSPICE", "code_information": [{"code": "G9858", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EVAL HIGH COMPLEX 45 MIN", "code_information": [{"code": "97163", "type": "CPT"}], "standard_charges": [{"minimum": 95.07, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 238.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EVAL MOD COMPLEX 30 MIN", "code_information": [{"code": "97162", "type": "CPT"}], "standard_charges": [{"minimum": 95.07, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EVALUATION HIGH COMPLEXITY", "code_information": [{"code": "4000143", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 238.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT EVALUATION LOW COMPLEXITY", "code_information": [{"code": "4000045", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 238.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT EVALUATION MODERATE COMPLEXITY", "code_information": [{"code": "4000142", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 238.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT F/U 30-180 DYS NO + IMPRV", "code_information": [{"code": "M1338", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT FALLS ASSESS-DOCD LE1/YR", "code_information": [{"code": "1101F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT FUNCT'L TRNG-15 MIN", "code_information": [{"code": "4000013", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 99.09, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT GAIT TRAINING", "code_information": [{"code": "4000014", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 86.13, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT GROUP THERAPY", "code_information": [{"code": "4000015", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 48.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT HAD >= 2-3 HPV VACCINES", "code_information": [{"code": "G9762", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HAS DOCD IMMUN TO HEP C", "code_information": [{"code": "3515F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HAS NO RESP INSUFFICIENCY", "code_information": [{"code": "1505F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HAS RESP INSUFFICIENCY", "code_information": [{"code": "1504F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HAS SYMP&SIGNS NEUROPATHY", "code_information": [{"code": "3753F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HCV RCTV ABY F/U NEG", "code_information": [{"code": "M1234", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HCV RCTV ABY NO F/U TST", "code_information": [{"code": "M1230", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HCV TST NO REACTIVE RES", "code_information": [{"code": "M1231", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HCV TST REACTIVE RESULT", "code_information": [{"code": "M1232", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HEMO < 3MO", "code_information": [{"code": "G1027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HEMO > 3MO", "code_information": [{"code": "G1026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HOSP DUR MSMT PERIOD", "code_information": [{"code": "G9691", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HOSPICE MNTH", "code_information": [{"code": "G0051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HX ACT DRAIN PREV 90 DAYS", "code_information": [{"code": "G8560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HX TOT COL OR COLON CA", "code_information": [{"code": "G9711", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HX TOT COL OR COLON CA", "code_information": [{"code": "M1295", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IMM CKPT INHIB THERAPY", "code_information": [{"code": "M1180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IMMUNITY TO HEP A DOCD", "code_information": [{"code": "3215F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IMMUNITY TO HEP B DOCD", "code_information": [{"code": "3216F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IN HOS", "code_information": [{"code": "G9690", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IN HOS", "code_information": [{"code": "G9758", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IN THE HOME PER DIEM", "code_information": [{"code": "S9131", "type": "HCPCS"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INELIG FOOTWEAR EVALUATIO", "code_information": [{"code": "G8416", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INELIG FOR REF OTO EVAL", "code_information": [{"code": "G8561", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INELIG REF OTO EVAL", "code_information": [{"code": "G8566", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INFO INTO RECALL SYSTEM", "code_information": [{"code": "7010F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INFOSYS ALARM 4 NXT MAMMO", "code_information": [{"code": "7025F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INITIATED ANTI-TNF AGENT", "code_information": [{"code": "G9914", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INR MEASUREMENT PERFORMED", "code_information": [{"code": "3555F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INSTR NO BD REST 4 DAYS/>", "code_information": [{"code": "4248F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INSTR NRML ACTIVITIES", "code_information": [{"code": "4245F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INTRVWD ON/BEFORE DX MDD", "code_information": [{"code": "2060F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IONTOPHORESIS", "code_information": [{"code": "4000018", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 89.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT IS W/HOSP DURING MSMT PER", "code_information": [{"code": "G9700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IS W/HOSP DURING MSMT PER", "code_information": [{"code": "G9714", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT JOINT MOBILIZATION", "code_information": [{"code": "4000019", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 83.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT KID TRANSPLT WTLST LV DON", "code_information": [{"code": "M1259", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT LESS 3D HOSPICE", "code_information": [{"code": "G9860", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT LFT INPT FAC W/IN 60 DAYS", "code_information": [{"code": "1110F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MANUAL THERAPY", "code_information": [{"code": "4000020", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 83.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT MASSAGE-15 MIN", "code_information": [{"code": "4000021", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 85.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT MBHT HD CT ORD EC PROV", "code_information": [{"code": "G9530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MBHT HD CT ORD EC PROV", "code_information": [{"code": "G9594", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MECH PROS HT VALV", "code_information": [{"code": "G0043", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MET DIS AT DX", "code_information": [{"code": "G9838", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MET DIS AT DX", "code_information": [{"code": "G9842", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MITRAL STENOSIS", "code_information": [{"code": "G0044", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MNTH 1 MCP PROV", "code_information": [{"code": "G1025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MORE THAN 3D HOSPICE", "code_information": [{"code": "G9861", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MYOFASCIAL RELEASE", "code_information": [{"code": "4000022", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 83.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT NEUROMUSCULAR RE-ED", "code_information": [{"code": "4000023", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 99.09, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT NO ABD IMG NO DOC RSN", "code_information": [{"code": "G9457", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO ACT KID TRANSPLT WTLST", "code_information": [{"code": "M1267", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO ANTIEMET PRE/INTRAOP", "code_information": [{"code": "G9777", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO BL SRG 30 DAY PST SRG", "code_information": [{"code": "G9627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO BWLI SRG 30 DAY SRG", "code_information": [{"code": "G9630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO CHEMO LAST 14D LIFE", "code_information": [{"code": "G9848", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO DAILY ASA/ANTIPLAT", "code_information": [{"code": "G9795", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO DOC HEAR LOSS", "code_information": [{"code": "G8567", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO F/U 30-180 DYS", "code_information": [{"code": "M1341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO HCV ABY OR RESULT", "code_information": [{"code": "M1233", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO HX ACT DRAIN 90 D", "code_information": [{"code": "G8562", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO KD TRNSPLT WTLST LV DO", "code_information": [{"code": "M1260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO PAM 3 PTS 6-12 MO", "code_information": [{"code": "M1349", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO PRM NURS HM RES IN PP", "code_information": [{"code": "M1059", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO REC TD/TDAP 9YRS PRIOR", "code_information": [{"code": "M1173", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO RECD ANTI-EGFR THER", "code_information": [{"code": "G9844", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO RECD CERV CYTO/HPV", "code_information": [{"code": "G9807", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO REF OTO REAS NO SPEC", "code_information": [{"code": "G8563", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO REF OTOLO NO SPEC", "code_information": [{"code": "G8568", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO REF, RN SPEC", "code_information": [{"code": "G0039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO RESP BEST INT", "code_information": [{"code": "M1240", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO RESP HEARD", "code_information": [{"code": "M1239", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO RESP IMPRT TO ME", "code_information": [{"code": "M1242", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO RESP SEEN AS PERSON", "code_information": [{"code": "M1241", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO SCRN SDOH", "code_information": [{"code": "M1208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO SUICD SAF PLN 120DY", "code_information": [{"code": "M1354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT 1 TDAP BETW 10-13 YRS", "code_information": [{"code": "G9417", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT ABLE TO PARTICIPATE", "code_information": [{"code": "G0037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT AMBUL/IMMOB/WC", "code_information": [{"code": "G9719", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT AMBUL/IMMOB/WC", "code_information": [{"code": "G9721", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT AMBULATORY", "code_information": [{"code": "M1068", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT CONSID POSS RISK FX", "code_information": [{"code": "3573F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT CURRENTLY ON STATIN", "code_information": [{"code": "G9796", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT DIED W/IN 30D OF PROC", "code_information": [{"code": "G9813", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT DISCH HOME DAY#2 EVAR", "code_information": [{"code": "G8833", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT ELI D/T ACT DIG HTN", "code_information": [{"code": "G9744", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT ELI D/T ACT DIG HTN", "code_information": [{"code": "M1290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT ELIG LOW NEURO EX", "code_information": [{"code": "G2178", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT ELIGIBLE ACE/ARB", "code_information": [{"code": "G8936", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT HAVE 2-3 HPV VACCINES", "code_information": [{"code": "G9763", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT RCVNG EPO THXPY", "code_information": [{"code": "4095F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT RCVNG ESA THXPY", "code_information": [{"code": "4172F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT RCVNG GLUCOCO THXPY", "code_information": [{"code": "4192F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT RCVNG WARF THXPY", "code_information": [{"code": "4301F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT RECVNG ANTIV HEP C", "code_information": [{"code": "4151F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT SCRN FUT FALL NO RSN", "code_information": [{"code": "M1070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT SCRN OR NO COUNSELING", "code_information": [{"code": "G9624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT TRANS TO HOSP AT D/C", "code_information": [{"code": "G8915", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOTRCVNG1ST ANTITNF TXMNT", "code_information": [{"code": "6150F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NT PRSC ADR DEP THRPY RNG", "code_information": [{"code": "G9897", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT OFFERED TX FOR PSEUDOBULB", "code_information": [{"code": "4541F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ON DAILY ASA/ANTIPLAT", "code_information": [{"code": "G9793", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT OR MANIP FOR MAINT", "code_information": [{"code": "S8990", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ORTHOTIC FITTING & TRAINING", "code_information": [{"code": "4000025", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 131.79, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT OTHR THN TRUE BEST INT", "code_information": [{"code": "M1244", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT OTHR THN TRUE HEARD", "code_information": [{"code": "M1243", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT OTHR THN TRUE IMPRT TO ME", "code_information": [{"code": "M1246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT OTHR THN TRUE PERSON", "code_information": [{"code": "M1245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT PAM INCR 3 PT 6-12 MO", "code_information": [{"code": "M1347", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT PAM INCR 6 PT 6-12 MO", "code_information": [{"code": "M1348", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT PAM LVL 4 BASE OR SRT LIN", "code_information": [{"code": "M1343", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT PARAFFIN BATH", "code_information": [{"code": "4000027", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 29.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT PERI DIALYSIS DUR MO", "code_information": [{"code": "G0052", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT PHONOPHORESIS", "code_information": [{"code": "4000028", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 38.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT PHYS/OCC THERAPY", "code_information": [{"code": "G0040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT PRES ANTIBIOTIC", "code_information": [{"code": "G8710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT PRM NURS HM RES IN PP", "code_information": [{"code": "M1058", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT PROSTHETIC TRAINING", "code_information": [{"code": "4000030", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 114.48, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT PROV HOSP SRV MSMT PER", "code_information": [{"code": "G9710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT QUERIED PAIN FXN W/ INSTR", "code_information": [{"code": "1502F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT QUERIED PRKNS COMPLIC", "code_information": [{"code": "4324F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT QUERIED SYMP RESP INSUFF", "code_information": [{"code": "1503F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCV <10MG DAILY PREDNISO", "code_information": [{"code": "4193F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCV >=10MG DAILY PREDNISO", "code_information": [{"code": "4194F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCV HEDIA OUTPT DYLS FAC", "code_information": [{"code": "G8956", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG ACE/ARB B-BLOCKERTX", "code_information": [{"code": "4480F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG ACE/ARB BLKER <3MOS", "code_information": [{"code": "4481F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG ANTI R-VIRAL THXPY", "code_information": [{"code": "4270F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG ANTI R-VIRAL THXPY", "code_information": [{"code": "4271F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG ANTI-RHEUM THXPY RA", "code_information": [{"code": "4195F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG EPO THXPY", "code_information": [{"code": "4090F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG ESA THXPY", "code_information": [{"code": "4171F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG PERITON DIALYSIS", "code_information": [{"code": "4055F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCVNG WARF THXPY", "code_information": [{"code": "4300F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RE-EVAL 15 MIN", "code_information": [{"code": "4000046", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 160.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT RE-EVAL EST PLAN CARE", "code_information": [{"code": "97164", "type": "CPT"}], "standard_charges": [{"minimum": 65.13, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 65.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REASON FOR NO BETA", "code_information": [{"code": "G9191", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REC'G RRT", "code_information": [{"code": "M1199", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECD 1 TD/TDAP 9YRS PRIOR", "code_information": [{"code": "M1171", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECD ANTI-EGFR THER", "code_information": [{"code": "G9845", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECD CERV CYTO/HPV", "code_information": [{"code": "G9806", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECD CHEMO LAST 14D LIFE", "code_information": [{"code": "G9847", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECD FLU VAX 7/1-6/30", "code_information": [{"code": "M1168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECD PCV ON/AFT 60", "code_information": [{"code": "M1177", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECV >=1 WELL-CHLD VISIT", "code_information": [{"code": "G9964", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECV TBCO CESS INTERV", "code_information": [{"code": "G9906", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECV TBCO CESS INTERV", "code_information": [{"code": "M1301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECVD 2 RX ANTI-EMET AGT", "code_information": [{"code": "4558F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECVD ASPIRIN W/IN 24 HRS", "code_information": [{"code": "4563F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECVD INHAL ANESTHETIC", "code_information": [{"code": "4554F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECVD NO INHAL ANESTHIC", "code_information": [{"code": "4555F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RECVNG ANTIVIR TXMNT HEPC", "code_information": [{"code": "4150F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REF APP RSRCS", "code_information": [{"code": "G2186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REF DOC OTO EVAL", "code_information": [{"code": "G8559", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REF FOR SPEECH LANG PATH", "code_information": [{"code": "4552F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REF OTO EVAL", "code_information": [{"code": "G8564", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REF PULM FX TEST/PEAKFLOW", "code_information": [{"code": "3758F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REFERRAL FOR ECT DOCD", "code_information": [{"code": "4067F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REFERRAL PSYCH DOCD", "code_information": [{"code": "4062F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REFRD 2 PVDR/SPCLST IN PP", "code_information": [{"code": "G9968", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RESP TRUE BEST INT", "code_information": [{"code": "M1247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RESP TRUE HEARD", "code_information": [{"code": "M1250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RESP TRUE IMPRT TO ME", "code_information": [{"code": "M1249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RESP TRUE SEEN AS PERSON", "code_information": [{"code": "M1248", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RSN NO ACE ARN ARNI", "code_information": [{"code": "G2094", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RSN NO ACE-I/ARB RX", "code_information": [{"code": "M1202", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RSN NO SCRN", "code_information": [{"code": "M1237", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCR FT FALL RSK", "code_information": [{"code": "M1069", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCR TOB & CESS INT", "code_information": [{"code": "G0030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCR TOB & CESS INT", "code_information": [{"code": "M1310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCREENED FOR DEPRESSION", "code_information": [{"code": "1220F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRN DYSPHAG/WT LOSS/NUTR", "code_information": [{"code": "3759F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRN SDOH", "code_information": [{"code": "M1207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRN TBCO AND ID AS USER", "code_information": [{"code": "G9902", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRN TBCO AND ID AS USER", "code_information": [{"code": "M1283", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRN TBCO ID AS NON USER", "code_information": [{"code": "G9903", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRN TBCO ID AS NON USER", "code_information": [{"code": "M1282", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRND HGH-RISK SEX BEHAV", "code_information": [{"code": "4293F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRND UNHLTHY OH USE", "code_information": [{"code": "3016F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCRNED FOR INJ DRUG USE", "code_information": [{"code": "4290F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SELECTIVE DEBRIDEMENT", "code_information": [{"code": "4000032", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 506.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT SELECTIVE DEBRIDEMENT >20 CENT", "code_information": [{"code": "4000033", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 32.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT SELF CARE MANAGEMENT", "code_information": [{"code": "4000034", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 97.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT SELF DSCHG", "code_information": [{"code": "M1148", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SFTY POS EXP W ANETH MVP", "code_information": [{"code": "G0059", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SPEC ALG RX-ONC TX OPTION", "code_information": [{"code": "794T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SURV IMPROV BSLINE TX", "code_information": [{"code": "G9603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SURV RESULTS NOT AVAIL", "code_information": [{"code": "G9604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT TALK PSYCHSOC&RX OH DPND", "code_information": [{"code": "4320F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT TELEHEALTH EVAL", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "4000145", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 95.07, "maximum": 763.85, "gross_charge": 367.92, "discounted_cash": 54.17, "estimated_discounted_cash": 238.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 95.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 294.33, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 331.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 209.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT THERAPEUTIC ACTIVITIES", "code_information": [{"code": "4000036", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 97.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT THERAPEUTIC EXERCISE", "code_information": [{"code": "4000037", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 89.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT TLK PSYCH & RX OPD ADDIC", "code_information": [{"code": "4306F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT TOBACCO SCREEN RCVD TLK", "code_information": [{"code": "4004F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT TRACTION", "code_information": [{"code": "4000038", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 44.82, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT TRANS FROM ANEST TO PACU", "code_information": [{"code": "G9656", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT TRANS TO HOSP POST D/C", "code_information": [{"code": "G8914", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT TREATD W/ORAL SYST OR BIO", "code_information": [{"code": "G9764", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT TRNSFRD FROM ANESTH TO CC", "code_information": [{"code": "581F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT UC IN PP", "code_information": [{"code": "M1021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT UC IN PP", "code_information": [{"code": "M1054", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ULTRA SOUND TREATMEN", "code_information": [{"code": "4000039", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 38.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT ULTRASOUND CONSTANT ATTEND", "code_information": [{"code": "4000031", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 38.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT UNABLE CMPLT LEPF PROM", "code_information": [{"code": "G9727", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT EWH FS PROM", "code_information": [{"code": "G9737", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT LB FS PROM", "code_information": [{"code": "G9733", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT LEPF PROM", "code_information": [{"code": "G9729", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT LEPF PROM", "code_information": [{"code": "G9731", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT UNBL CMPLT SHLD FS PROM", "code_information": [{"code": "G9735", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT UNNA BOOT APPLICATION", "code_information": [{"code": "4000040", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 283.62, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT USE HOSP DURING MSMT PER", "code_information": [{"code": "G9693", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT USE HOSP DURING MSMT PER", "code_information": [{"code": "G9702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT USE HOSP DURING MSMT PER", "code_information": [{"code": "G9713", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT USE HSPC DUR MEAS PD", "code_information": [{"code": "M1165", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT VASOPNEUMATIC DEVICE", "code_information": [{"code": "4000041", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 53.82, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT VASOPNEUMATIC TREATM", "code_information": [{"code": "4000042", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 53.82, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT W 2 HZV ON/AFT 50", "code_information": [{"code": "M1174", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W IV AB GIVEN ON TIME", "code_information": [{"code": "G8916", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W IV AB NOT GIVEN ON TIME", "code_information": [{"code": "G8917", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ +HCV +VIR REF WIN 1 MO", "code_information": [{"code": "M1229", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ CKD STG 5", "code_information": [{"code": "M1188", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ CORONARY ARTERY STENT", "code_information": [{"code": "4561F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ DEMENTIA ANY TIME", "code_information": [{"code": "M1164", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ DX OSTEO DOE", "code_information": [{"code": "M1153", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ DX SQ CELL CA OF ESOPH", "code_information": [{"code": "M1192", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ ESRD", "code_information": [{"code": "M1187", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ HX TRNSPLT OR LVAD", "code_information": [{"code": "M1151", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ HX TRNSPLT OR LVAD", "code_information": [{"code": "M1152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ LMTED LIFE EXPEC", "code_information": [{"code": "G0050", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ RX FOR HSPC/PLLTV CARE", "code_information": [{"code": "M1186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ SUIC SAF PLN INIT REV", "code_information": [{"code": "M1350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/3+ POST-OP NAUSEA&VOM", "code_information": [{"code": "4556F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/90D MRS 0-2", "code_information": [{"code": "G9646", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/90D MRS >2", "code_information": [{"code": "G9648", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ABN LVEF B-BLOC NO RX", "code_information": [{"code": "G8452", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ABN LVEF INELIG B-BLOC", "code_information": [{"code": "G8451", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/C MANAGEMENT", "code_information": [{"code": "4000043", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 84.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT W/CANCER SCOLIOSIS", "code_information": [{"code": "G9945", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/CANCER SCOLIOSIS", "code_information": [{"code": "M1051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/CLIN ASCVD DX", "code_information": [{"code": "G9674", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/DOC USE ANTICOAG MST YR", "code_information": [{"code": "G9724", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/DXA NO RESULTS DOC", "code_information": [{"code": "G8400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/DXA RESULTS DOCUMENT", "code_information": [{"code": "G8399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/DYSPHAG/WT LOSS/NUTR", "code_information": [{"code": "3760F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/FAST/DIR LAB LDL-C >190", "code_information": [{"code": "G9675", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9688", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9741", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9761", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9768", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9805", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/HOSP ANYTIME MSMT PER", "code_information": [{"code": "G9819", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/O 3+ POST-OPNAUSEA&VOM", "code_information": [{"code": "4557F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/O CORONARY ARTERY STENT", "code_information": [{"code": "4562F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/O DYSPHAG/WT LOSS/NUTR", "code_information": [{"code": "3761F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/O FLU VAX 7/1-6/30", "code_information": [{"code": "M1170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/O HZV ON/AFT AGE 50", "code_information": [{"code": "M1176", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/O PREOP ORDER IV AB PRO", "code_information": [{"code": "G8918", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/O PSEUDOBULBAFFECT/ALS", "code_information": [{"code": "3757F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/PSEUDOBULB AFFECT/ALS", "code_information": [{"code": "3756F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/RED SUIC IDEA 120 DAYS", "code_information": [{"code": "M1357", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT WHIRLPOOL SUPERVISED", "code_information": [{"code": "4000044", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 64.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PT, PN, HIST GRADE DOC", "code_information": [{"code": "G8721", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT, PN, HIST GRADE NOT DOC", "code_information": [{"code": "G8724", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT-FOCUSED HLTH RISK ASSMT", "code_information": [{"code": "96160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT/CAREGIVER COUNSEL SAFETY", "code_information": [{"code": "6090F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT/CAREGIVER QUERIED FALLS", "code_information": [{"code": "6080F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT/CAREGIVER TRAING HOME INR", "code_information": [{"code": "93792", "type": "CPT"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT/PTN DECLN ASSESS", "code_information": [{"code": "G0036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT/PTN DECLN REFERRAL", "code_information": [{"code": "G0041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT=D(RH)+ OR SENSITIZED", "code_information": [{"code": "3291F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT=D(RH)- AND UNSENSITIZED", "code_information": [{"code": "3290F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTCA W/ PLCMT BRACHYTX DEV", "code_information": [{"code": "C7533", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTEN FULL GENE ANALYSIS", "code_information": [{"code": "235U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTEN GENE DUP/DELET VARIANT", "code_information": [{"code": "81323", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 345.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTEN GENE FULL SEQUENCE", "code_information": [{"code": "81321", "type": "CPT"}], "standard_charges": [{"minimum": 690.0, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTEN GENE KNOWN FAM VARIANT", "code_information": [{"code": "81322", "type": "CPT"}], "standard_charges": [{"minimum": 53.59, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTFALLS ASSESS-DOCD GE2>/YR", "code_information": [{"code": "1100F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTNOT RCVNG ANTI-RHM THXPYRA", "code_information": [{"code": "4196F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTNOTRCVNGSTEROID>=10MG/DAY", "code_information": [{"code": "3750F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS 7WK INJ, SCRN IOP =<25", "code_information": [{"code": "M1322", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS 7WK INJ, SCRN IOP >25", "code_information": [{"code": "M1323", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS ACT PVD 2 WKS 2 WKS", "code_information": [{"code": "M1334", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS ACT PVD 2 WKS 8 WKS", "code_information": [{"code": "M1329", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS ADMIT SNF", "code_information": [{"code": "M1266", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS BREASTFEEDING", "code_information": [{"code": "G9779", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS COUNSL CPT OPT OUT", "code_information": [{"code": "M1317", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS CSP DOC CONTACT", "code_information": [{"code": "M1319", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS DECEASED PRIOR HU SURV", "code_information": [{"code": "M1254", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS DEM ANY TIME/DUR MO", "code_information": [{"code": "M1271", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS DIED PERF PER", "code_information": [{"code": "M1342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS DX ACUTE VITREOUS HEM", "code_information": [{"code": "M1328", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS DX HYPOTONY", "code_information": [{"code": "M1326", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS DX W/RHABDOMYOLYSIS", "code_information": [{"code": "G9780", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS EVAL INI XM 2 WKS", "code_information": [{"code": "M1336", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS EVAL INI XM 8 WKS", "code_information": [{"code": "M1331", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS F/U 30-180 DYS + IMPROV", "code_information": [{"code": "M1339", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS HOSP DIALYSIS DT", "code_information": [{"code": "M1263", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS HOSP EXL", "code_information": [{"code": "M1275", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS HU SURV NO AMB PLLTV", "code_information": [{"code": "M1253", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS INTRAVITREAL/PCI", "code_information": [{"code": "M1324", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS KID TRANSPLT WTLST", "code_information": [{"code": "M1272", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO 7WK INJ,NO IOP,IOP>25", "code_information": [{"code": "M1321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO <SUICD IDEA 120 DYS", "code_information": [{"code": "M1358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO BSLN OR 2ND PAM SCORE", "code_information": [{"code": "M1344", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO CMPLT HU SURVEY", "code_information": [{"code": "M1252", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO CMPLT SUICD SAF PLN", "code_information": [{"code": "M1353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO CSP DOC CONTACT", "code_information": [{"code": "M1318", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO EVAL INI XM NO 2 WKS", "code_information": [{"code": "M1332", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO EVAL INI XM NO 8 WKS", "code_information": [{"code": "M1327", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO F/U 120 DYS", "code_information": [{"code": "M1363", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO KID TRANSPLT WTLST", "code_information": [{"code": "M1270", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS NO PAM 6 PTS 6-12 MO", "code_information": [{"code": "M1346", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS ON WTLIST BEF DIALYSIS", "code_information": [{"code": "M1261", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS PROXY CMPLT HU SURV", "code_information": [{"code": "M1251", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS SCRN + HRSN", "code_information": [{"code": "M1320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS SNF 1 YR DIALYSIS", "code_information": [{"code": "M1273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS SNF EXL MO", "code_information": [{"code": "M1274", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS TRANSPLT BEF DIALYSIS", "code_information": [{"code": "M1262", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTS W/ OTHR RSN VST,+PRG TST", "code_information": [{"code": "M1255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTT", "code_information": [{"code": "85730", "type": "CPT"}, {"code": "1000085", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.91, "maximum": 31.96, "gross_charge": 35.52, "discounted_cash": 54.17, "estimated_discounted_cash": 35.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 28.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 31.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 20.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92997", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92998", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULM DS IPF MRNA 190 GEN ALG", "code_information": [{"code": "81554", "type": "CPT"}], "standard_charges": [{"minimum": 6325.0, "maximum": 6325.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6325.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULM FUNCT TST PLETHYSMOGRAP", "code_information": [{"code": "94726", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULM FUNCTION TEST BY GAS", "code_information": [{"code": "94727", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULM FX W/IN 12 MON B/4 SURG", "code_information": [{"code": "3038F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS PREV CT", "code_information": [{"code": "807T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS W/CT", "code_information": [{"code": "808T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULMICORT (BUDESONIDE) 0.5MG/2ML INHAL.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000858", "type": "CDM"}, {"code": "00093681655", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PULMICORT (BUDESONIDE) INH 0.25MG/2ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000307", "type": "CDM"}, {"code": "00093681573", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [{"code": "189", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 11539.9, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [{"code": "175", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [{"code": "176", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PULMONARY FUNCTION TEST", "code_information": [{"code": "94010", "type": "CPT"}, {"code": "4200011", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 107.5, "maximum": 169.74, "gross_charge": 188.61, "discounted_cash": 54.17, "estimated_discounted_cash": 188.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 141.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 150.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 169.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 107.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONARY REHAB REC", "code_information": [{"code": "4033F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULMONARY REHABILITATION PRO", "code_information": [{"code": "S9473", "type": "HCPCS"}], "standard_charges": [{"minimum": 113.48, "maximum": 113.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 113.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULMONARY STRESS TESTING", "code_information": [{"code": "94618", "type": "CPT"}], "standard_charges": [{"minimum": 326.52, "maximum": 326.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 326.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULMONOLOGY SS", "code_information": [{"code": "G4030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULP CAP DIRECT", "code_information": [{"code": "D3110", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULP CAP INDIRECT", "code_information": [{"code": "D3120", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULP VITALITY TEST", "code_information": [{"code": "D0460", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION COMPLETE", "code_information": [{"code": "D3357", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION INITIAL", "code_information": [{"code": "D3355", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION INTERIM", "code_information": [{"code": "D3356", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULPAL THERAPY ANTERIOR PRIM", "code_information": [{"code": "D3230", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULPAL THERAPY POSTERIOR PRI", "code_information": [{"code": "D3240", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULSE OXIMETER", "code_information": [{"code": "80001250", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 39.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PUMP CANISTER CONNECTOR", "code_information": [{"code": "3001119", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "11105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "11104", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BREAST", "code_information": [{"code": "19000", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BRST EA", "code_information": [{"code": "19001", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PUNCTURE/CLEAR WINDPIPE", "code_information": [{"code": "31612", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PURAPLY 1 SQ CM", "code_information": [{"code": "Q4195", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 1 SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PURAPLY XT 1 SQ CM", "code_information": [{"code": "Q4197", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PURE TONE AUDIOMETRY AIR", "code_information": [{"code": "92552", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PURE TONE HEARING TEST AIR", "code_information": [{"code": "92551", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PURILON GEL 0.53OZ", "code_information": [{"code": "3000269", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PVB THORACIC 2ND+ INJ SITE", "code_information": [{"code": "64462", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC CONT INFUSION", "code_information": [{"code": "64463", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC SINGLE INJ SITE", "code_information": [{"code": "64461", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PVDR RFRD PT NO RPRT RCVD", "code_information": [{"code": "G9970", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PVDR RFRD PT RPRT RCVD", "code_information": [{"code": "G9969", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP 4 HD SEAT/BACK", "code_information": [{"code": "K0870", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP 4 STD CAP CHAIR", "code_information": [{"code": "K0869", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP 4 STD SEAT/BACK", "code_information": [{"code": "K0868", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP 4 VHD SEAT/BACK", "code_information": [{"code": "K0871", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP2 STD SEAT ELEVATE CAP", "code_information": [{"code": "K0831", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP2 STD SEAT ELEVATE S/B", "code_information": [{"code": "K0830", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP4 HD MULT POW S/B", "code_information": [{"code": "K0886", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP4 HD SING POW OPT S/B", "code_information": [{"code": "K0879", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP4 STD MULT POW OPT CAP", "code_information": [{"code": "K0885", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP4 STD MULT POW OPT S/B", "code_information": [{"code": "K0884", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP4 STD SING POW OPT CAP", "code_information": [{"code": "K0878", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP4 STD SING POW OPT S/B", "code_information": [{"code": "K0877", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP4 VHD SING POW OPT S/B", "code_information": [{"code": "K0880", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP5 PED MULT POW OPT S/B", "code_information": [{"code": "K0891", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWC GP5 PED SING POW OPT S/B", "code_information": [{"code": "K0890", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWR PACK BASE ELEC VAD, REP", "code_information": [{"code": "Q0488", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PWR STANDING", "code_information": [{"code": "E2301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PX SUP FEE ANTI-CAN SUB PRES", "code_information": [{"code": "Q0512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/DRG PYELOSTOMY", "code_information": [{"code": "50125", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/EXPLORATION", "code_information": [{"code": "50120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/REMOVAL CALCULUS", "code_information": [{"code": "50130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYRIDIUM (PHENAZOPYRIDINE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000363", "type": "CDM"}, {"code": "65162068110", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PYRIDOXINE HCL 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation", "code_information": [{"code": "C1605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PalinGen Dual-Layer Membrane, per square centimeter", "code_information": [{"code": "Q4354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Palisade DM matrix, per square centimeter", "code_information": [{"code": "Q4350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Partial craniectomy, channel creation, and tunneling of electrode for sub-scalp implantation of an electrode array, receiver, and telemetry unit for continuous bilateral electroencephalography monitoring system, including imaging guidance", "code_information": [{"code": "956T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Partial hand including fingers, flexible or non-flexible interface, endoskeletal system, molded to patient model, for use without external power, not including inserts described by l6692", "code_information": [{"code": "L6028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patient encounter during the performance period with place of service code 11", "code_information": [{"code": "M1382", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and", "code_information": [{"code": "G0535", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patient received hospice services any time during the performance period", "code_information": [{"code": "M1416", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients on a therapeutic clinical trial", "code_information": [{"code": "M1396", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients on a therapeutic clinical trial", "code_information": [{"code": "M1404", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group", "code_information": [{"code": "M1395", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group", "code_information": [{"code": "M1402", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who are not up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination", "code_information": [{"code": "M1419", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who are not up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination because of a medical contraindication documented by clinician", "code_information": [{"code": "M1418", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who are up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination", "code_information": [{"code": "M1417", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who did not have a positive PD-L1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy", "code_information": [{"code": "M1415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who did not have germline testing for BRCA1 and BRCA2 or genetic counseling completed within 6 months of diagnosis", "code_information": [{"code": "M1410", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who died during the follow-up period", "code_information": [{"code": "M1400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who died during the follow-up period", "code_information": [{"code": "M1407", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who died during the performance period", "code_information": [{"code": "M1384", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who died during the performance period", "code_information": [{"code": "M1387", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period", "code_information": [{"code": "M1390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who had a positive PD-L1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy", "code_information": [{"code": "M1413", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who have germline BRCA testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer", "code_information": [{"code": "M1408", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who leave the practice during the follow-up period", "code_information": [{"code": "M1399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who leave the practice during the follow-up period", "code_information": [{"code": "M1406", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who received germline testing for BRCA1 and BRCA2 or genetic counseling completed within 6 months of diagnosis", "code_information": [{"code": "M1409", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients who were not diagnosed with recurrent melanoma during the current performance period", "code_information": [{"code": "M1393", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial ajcc staging of 0, i, or ii at the start of the performance period", "code_information": [{"code": "M1386", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients with baseline and follow-up PROMIS surveys documented in the medical record", "code_information": [{"code": "M1403", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients with baseline and follow-up promis surveys documented in the medical record", "code_information": [{"code": "M1398", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients with documentation of an exam performed for recurrence of melanoma", "code_information": [{"code": "M1388", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients with metastatic NSCLC with epidermal growth factor receptor (EGFR) mutations, ALK genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as NSCLC with ROS1 rearrangement, BRAF V600E mu", "code_information": [{"code": "M1412", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients with recurrence/disease progression", "code_information": [{"code": "M1397", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients with recurrence/disease progression", "code_information": [{"code": "M1405", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure", "code_information": [{"code": "M1381", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pectus carinatum ortho cust", "code_information": [{"code": "L1320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered int", "code_information": [{"code": "G0536", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PelloGraft, per square centimeter", "code_information": [{"code": "Q4320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Penile contracture device, manual, greater than 3 lbs traction force", "code_information": [{"code": "E0201", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon (eg, drug-coated, drug-eluting) performed on a separate target lesion from the target lesion treated with balloon angioplasty, coronary stent placement or coronary", "code_information": [{"code": "914T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon (eg, drug-coated, drug-eluting), including mechanical dilation by nondrug-delivery balloon angioplasty, endoluminal imaging using intravascular ultrasound (IVUS) o", "code_information": [{"code": "913T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance with intravascular ultrasound (noncoronary vessel(s)) during diagnostic evaluation and/or therapeutic i", "code_information": [{"code": "C7564", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Perfluoroalkyl substances (PFAS) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), 9 PFAS compounds by LC-MS/MS, plasma or serum, quantitative", "code_information": [{"code": "457U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Perfluoroalkyl substances (PFAS) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), by liquid chromatography with tandem mass spectrometry (LC-MS/MS), plasma or serum, quantitative", "code_information": [{"code": "535U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Personalized target development for accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation derived from a structural and resting-state functional MRI, including data preparation and transmission, generation of the tar", "code_information": [{"code": "889T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pessary, disposable any type", "code_information": [{"code": "A4564", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pharmacy supplying fee for HIV pre-exposure prophylaxis FDA approved prescription", "code_information": [{"code": "Q0521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Photobiomodulation therapy of retina, single session", "code_information": [{"code": "936T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Placement of bone marrow sampling port, including imaging guidance when performed", "code_information": [{"code": "901T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use", "code_information": [{"code": "90684", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, 4 calls per calendar month", "code_information": [{"code": "G0544", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Post-operative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the sam", "code_information": [{"code": "G0559", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Powered, single-use (i.e. disposable) endoscopic ultrasound-guided biopsy device", "code_information": [{"code": "C1738", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Preparation of skin cell suspension autograft, automated, including all enzymatic processing and device components (Do not report with manual suspension preparation)", "code_information": [{"code": "C8002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; each additional 25 sq cm of harvested skin or part thereof (List separately in addition to code for primary proc", "code_information": [{"code": "15014", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; first 25 sq cm or less of harvested skin", "code_information": [{"code": "15013", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Procenta, per 100 mg", "code_information": [{"code": "Q4310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, implantable cardiac contractility m", "code_information": [{"code": "926T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Programming of subcutaneously implanted peritoneal ascites pump system by physician or other qualified health care professional", "code_information": [{"code": "875T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Protonix (Pantoprazole Sod.) Powder 40MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003924", "type": "CDM"}, {"code": "27241025638", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 30.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring", "code_information": [{"code": "G0555", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pulmonology care MIPS value pathway", "code_information": [{"code": "M1424", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pwr seat elev sys for crt", "code_information": [{"code": "E2298", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Q FEVER ANTIBODY", "code_information": [{"code": "86638", "type": "CPT"}], "standard_charges": [{"minimum": 13.94, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QMRCP W/DX MRI SAME ANATOMY", "code_information": [{"code": "724T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QMRCP W/O DX MRI SM ANAT SES", "code_information": [{"code": "723T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 11-20", "code_information": [{"code": "98971", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 21+", "code_information": [{"code": "98972", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QNHP OL DIG ASSMT&MGMT 5-10", "code_information": [{"code": "98970", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QTc interval derived by augmentative algorithmic analysis of input from an external, patient-activated mobile ECG device", "code_information": [{"code": "902T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAL CARD DIAG PRIOR 12 MONS", "code_information": [{"code": "1460F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAL CARE ENT DISORDER MVP", "code_information": [{"code": "M1367", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUALCARE MENTAL HLTH/SUD MVP", "code_information": [{"code": "M1369", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN CT TISS CHARAC W/CT", "code_information": [{"code": "722T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN CT TISS CHARAC W/O CT", "code_information": [{"code": "721T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN MR TIS WO MRI 1ORGN", "code_information": [{"code": "648T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN MR TIS WO MRI MLT ORGN", "code_information": [{"code": "697T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN MR TISS W/MRI 1ORGN", "code_information": [{"code": "649T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN MR TISS W/MRI MLT ORGN", "code_information": [{"code": "698T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN MRI ALYS BRN W/DX MRI", "code_information": [{"code": "866T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN MRI ALYS BRN W/O DX MRI", "code_information": [{"code": "865T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN PUPLMTRY PHY/QHP UNI/BI", "code_information": [{"code": "95919", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN US TIS CHARAC W/DX US", "code_information": [{"code": "690T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUAN US TIS CHARAC W/O DX US", "code_information": [{"code": "689T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUANT HER2 IHC EVAL BRST CX", "code_information": [{"code": "3394F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUANT NONHER2 IHC BRST CX", "code_information": [{"code": "3395F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUANT RESULTS ACTIVITY &SYMP", "code_information": [{"code": "3115F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "QUANTIFERON TUBERCULOSIS GOLD TEST", "code_information": [{"code": "86480", "type": "CPT"}, {"code": "1000739", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 71.28, "maximum": 310.2, "gross_charge": 344.67, "discounted_cash": 54.17, "estimated_discounted_cash": 344.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 71.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 275.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 310.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 196.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUESTRAN POWDER 4GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000787", "type": "CDM"}, {"code": "67877029860", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "QUININE SULFATE TAB 324MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000372", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "QUINUPRISTIN/DALFOPRISTIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2770", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.3, "maximum": 631.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Quantitative software measurements of cardiac volume, cardiac chambers volumes and left ventricular wall mass derived from CT scan(s) data of the chest/heart (with or without contrast)", "code_information": [{"code": "G0183", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7522", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANG HRT FLOW", "code_information": [{"code": "C7552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANGIO", "code_information": [{"code": "93457", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93594", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93593", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT CORONARY ARTERY ANGIO", "code_information": [{"code": "93456", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&I HRT ART/VENT ANG DRG AD", "code_information": [{"code": "C7553", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7527", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7528", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93460", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93461", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93597", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93596", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH W/VENTRICLGRPHY", "code_information": [{"code": "93453", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R&L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7529", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R-T PRS SENSING EDRL GDN SYS", "code_information": [{"code": "777T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R-T SPCTRL ALYS PRST8 TISS", "code_information": [{"code": "443T", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RA DISEASE ACTIVITY HIGH", "code_information": [{"code": "3472F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RA DISEASE ACTIVITY LOW", "code_information": [{"code": "3470F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RA DISEASE ACTIVITY MOD", "code_information": [{"code": "3471F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RA TRACER ID OF SENTINL NODE", "code_information": [{"code": "38792", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RABIES IG HEAT TREATED", "code_information": [{"code": "90376", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUMAN IM/SC", "code_information": [{"code": "90377", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC", "code_information": [{"code": "90375", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE ID", "code_information": [{"code": "90676", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM", "code_information": [{"code": "90675", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RACEPINEPHRINE 2.25% INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000415", "type": "CDM"}, {"code": "00487590199", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RAD DOS LIMTS B/4 3D RAD", "code_information": [{"code": "520F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD EXC LESION UP TO 1.25 CM", "code_information": [{"code": "D7410", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD EXPOS IND/EXP TM DOC", "code_information": [{"code": "G9500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD EXPOS IND/EXP TM NO DOC", "code_information": [{"code": "G9501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM DSTL/SHFT HUM", "code_information": [{"code": "24150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E 5 CM+", "code_information": [{"code": "24079", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E <5CM", "code_information": [{"code": "24077", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD RESECT ABD TUMOR 5 CM/>", "code_information": [{"code": "22905", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR 3 CM/>", "code_information": [{"code": "26118", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR < 3 CM", "code_information": [{"code": "26117", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAD RESECTION TUM RADIAL H/N", "code_information": [{"code": "24152", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIAL KERATOTOMY", "code_information": [{"code": "65771", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION APPLICATOR", "code_information": [{"code": "D5983", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION CONE LOCATOR", "code_information": [{"code": "D5985", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION HANDLING", "code_information": [{"code": "77790", "type": "CPT"}], "standard_charges": [{"minimum": 25.15, "maximum": 25.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION ONCOLOGY SS", "code_information": [{"code": "G4031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77336", "type": "CPT"}], "standard_charges": [{"minimum": 130.09, "maximum": 3515.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3515.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77370", "type": "CPT"}], "standard_charges": [{"minimum": 207.17, "maximum": 3515.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 207.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3515.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION SHIELD", "code_information": [{"code": "D5984", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY DOSE PLAN", "code_information": [{"code": "77300", "type": "CPT"}], "standard_charges": [{"minimum": 106.37, "maximum": 106.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 106.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY MANAGEMENT", "code_information": [{"code": "77431", "type": "CPT"}], "standard_charges": [{"minimum": 179.27, "maximum": 1008.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 179.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77261", "type": "CPT"}], "standard_charges": [{"minimum": 120.17, "maximum": 120.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 120.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77262", "type": "CPT"}], "standard_charges": [{"minimum": 182.16, "maximum": 182.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 182.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77263", "type": "CPT"}], "standard_charges": [{"minimum": 284.71, "maximum": 284.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 284.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77332", "type": "CPT"}], "standard_charges": [{"minimum": 63.52, "maximum": 63.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 63.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77333", "type": "CPT"}], "standard_charges": [{"minimum": 224.92, "maximum": 224.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 224.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77334", "type": "CPT"}], "standard_charges": [{"minimum": 202.49, "maximum": 202.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 202.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77401", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77402", "type": "CPT"}], "standard_charges": [{"minimum": 209.09, "maximum": 209.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 209.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77407", "type": "CPT"}], "standard_charges": [{"minimum": 286.62, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 286.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77412", "type": "CPT"}], "standard_charges": [{"minimum": 380.75, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6004", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6005", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6006", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6007", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6008", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6009", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6010", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6011", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6013", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6014", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TX DELIVERY IMRT", "code_information": [{"code": "G6015", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.0, "maximum": 584.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIATION TX MANAGEMENT X5", "code_information": [{"code": "77427", "type": "CPT"}], "standard_charges": [{"minimum": 321.06, "maximum": 1008.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 321.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECT ABD TUMOR<5CM", "code_information": [{"code": "22904", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION OF ELBOW", "code_information": [{"code": "24149", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIESSE INJECTION", "code_information": [{"code": "Q2026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIO/SURGICAL IMPLANT INDEX", "code_information": [{"code": "D6190", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIOLOGY PORT IMAGES(S)", "code_information": [{"code": "77417", "type": "CPT"}], "standard_charges": [{"minimum": 19.8, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIOPHARM DX AGENT NOC", "code_information": [{"code": "A4641", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIOPHARM RX AGENT NOC", "code_information": [{"code": "A9699", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY", "code_information": [{"code": "849", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY DOSE PLAN IMRT", "code_information": [{"code": "77301", "type": "CPT"}], "standard_charges": [{"minimum": 2935.01, "maximum": 2935.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2935.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADIUM RA223 DICHLORIDE THER", "code_information": [{"code": "A9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RADXPS IN END RPRT4FLURO PXD", "code_information": [{"code": "6045F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFS CRS EWH NO SCOR NO SURV", "code_information": [{"code": "G8670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFS CRS HI NO SCOR NO SURV", "code_information": [{"code": "G8654", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFS CRS KI NO SCOR NO RSN", "code_information": [{"code": "G8650", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFS CRS LBI NO SCOR NO SURV", "code_information": [{"code": "G8662", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFS CRS SI NO SCOR NO SURV", "code_information": [{"code": "G8666", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS EWH SCOR < 0", "code_information": [{"code": "G8668", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS EWH SCOR >= 0", "code_information": [{"code": "G8667", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS HI SCOR < 0", "code_information": [{"code": "G8652", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS HI SCOR >=0", "code_information": [{"code": "G8651", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS KI SCOR < 0", "code_information": [{"code": "G8648", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS KI SCOR >= 0", "code_information": [{"code": "G8647", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LBI NO SCOR", "code_information": [{"code": "G8661", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LBI SCOR < 0", "code_information": [{"code": "G8660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LBI SCOR >= 0", "code_information": [{"code": "G8659", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LLFAI NO SCOR + SURV", "code_information": [{"code": "G8658", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LLFAI SCOR < 0", "code_information": [{"code": "G8656", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS LLFAI SCOR >= 0", "code_information": [{"code": "G8655", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS SI SCOR < 0", "code_information": [{"code": "G8664", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAFSCRS SI SCOR >= 0", "code_information": [{"code": "G8663", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RANEXA ER (RANOLAZINE) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000338", "type": "CDM"}, {"code": "31722066860", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 17.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RANGE OF MOTION MEASUREMENTS", "code_information": [{"code": "95851", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RANGE OF MOTION MEASUREMENTS", "code_information": [{"code": "95852", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RANIBIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2778", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAPAFLO (SILODOSIN) 4MG CAPSULE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004340", "type": "CDM"}, {"code": "27241014401", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RAPID CLOSTRIDIUM DIFFICILE A/B", "code_information": [{"code": "87324", "type": "CPT"}, {"code": "1000564", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.78, "maximum": 63.9, "gross_charge": 71.01, "discounted_cash": 54.17, "estimated_discounted_cash": 71.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAPID DESENSITIZATION", "code_information": [{"code": "95180", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAPID RHINO NASAL PACKING 5.5", "code_information": [{"code": "3001433", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 179.46, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RAPID RHINO NASAL PACKING 7.5", "code_information": [{"code": "3001179", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 146.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RAR DO WHL GN&MTCDRL DNA ALS", "code_information": [{"code": "265U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DO ID OPT GEN MAPG&SEQ", "code_information": [{"code": "267U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS EA COMP", "code_information": [{"code": "213U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS PROBAND", "code_information": [{"code": "212U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DS ID OPT GENOME MAPG", "code_information": [{"code": "260U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DS ID OPT GENOME MAPG", "code_information": [{"code": "264U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DS WHL GEN SEQ BLD/SLV", "code_information": [{"code": "336U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DS WHL GEN SEQ FETA", "code_information": [{"code": "335U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM DNA ALYS EA COMP", "code_information": [{"code": "215U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM DNA ALYS PROBAND", "code_information": [{"code": "214U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RASBURICASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2783", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RAST-ALMONDS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000580", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-ALTERNARIA ALTERNATA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000724", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-ASPERGILLUS AMSTELODAMI", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000721", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-ASPERGILLUS FUMIGATUS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000718", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-ASPERGILLUS NIDULANS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000723", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-ASPERGILLUS NIGER", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000722", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-ASPERGILLUS TERREUS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000720", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-ASPERGILLUS VERICOLOR", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000719", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-BAHIA GRASS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000707", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-BANANA", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000627", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-BERMUDA GRASS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000866", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-BRAZIL NUTS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000583", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-CASHEW NUT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000577", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-CAT HAIR/DANDER", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000708", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-CEDAR, MOUNTAIN", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000880", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-CINNAMON", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000864", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-CLADOSPORIUM HERBARUM", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000725", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-COCKROACH, AMERICAN", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000869", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-CORN", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000862", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-COTTON LINT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000589", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-COW MILK", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000591", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-CRAB", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000697", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-CRAWFISH", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000893", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-D.FAIRNAE MITE", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000710", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-D.PTERONYSSINUS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000711", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-DOG DANDER", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000865", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-DOG HAIR", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000709", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-EGG WHOLE", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000863", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-ELM, AMERICAN", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000874", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-HAZELNUT (FILBERT)", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000585", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-HICKORY, WHITE", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000876", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-JOHNSON GRASS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000868", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-KIWI FRUIT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000628", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-LATEX", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000629", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-LOBSTER", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000891", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-MACADAMIA NUT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000579", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-MAPLE/BOX ELDER", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000875", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-MUCOR RACEMOSUS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000871", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-MUGWORT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000881", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-MUSTARD", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000588", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-NETTLE", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000885", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-OAK, WHITE", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000873", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-PEANUT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000590", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-PECAN NUT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000578", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-PENICILLIUM NOTATUM", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000870", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-PIGWEED, ROUGH", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000883", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-PINE NUT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000584", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-PISTACHIOS", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000582", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-PLANTAIN, ENGLISH", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000882", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-RAGWEED,SHORT/COMMON", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000706", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-SHEEP SORREL", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000884", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-SHRIMP", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000892", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-SOYBEAN", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000698", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-STEMPHYLIUM HERBARUM", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000872", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-SWEET GUM", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000879", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-SYCAMORE, MAPLE LEAF", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000877", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-TIMOTHY", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000867", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-TOMATO", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000587", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-WALNUT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000586", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-WHEAT", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000861", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAST-WHITE MULBERRY", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "1000878", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.0, "maximum": 33.38, "gross_charge": 30.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAZOR", "code_information": [{"code": "3000270", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RB82 RUBIDIUM", "code_information": [{"code": "A9555", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC ANTIBODY ELUTION", "code_information": [{"code": "86860", "type": "CPT"}], "standard_charges": [{"minimum": 32.51, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC DEGLYCEROLIZED", "code_information": [{"code": "P9039", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC DEPLETION OF HARVEST", "code_information": [{"code": "38212", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 10 BLD GROUPS", "code_information": [{"code": "84U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 16 BLD GROUPS", "code_information": [{"code": "246U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNTYP 12 BLD GRP GEN", "code_information": [{"code": "282U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC DNA HEA 35 AG 11 BLD GRP", "code_information": [{"code": "1U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC IRRADIATED", "code_information": [{"code": "P9038", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC LEUKOREDUCED IRRADIATED", "code_information": [{"code": "P9040", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC MECHANICAL FRAGILITY", "code_information": [{"code": "85547", "type": "CPT"}], "standard_charges": [{"minimum": 9.89, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC OSMOTIC FRAGILITY", "code_information": [{"code": "85555", "type": "CPT"}], "standard_charges": [{"minimum": 8.59, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC OSMOTIC FRAGILITY", "code_information": [{"code": "85557", "type": "CPT"}], "standard_charges": [{"minimum": 15.36, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC PRETREATMENT SERUM", "code_information": [{"code": "86978", "type": "CPT"}], "standard_charges": [{"minimum": 13.73, "maximum": 36.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/CHEMICL", "code_information": [{"code": "86970", "type": "CPT"}], "standard_charges": [{"minimum": 30.04, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/DENSITY", "code_information": [{"code": "86972", "type": "CPT"}], "standard_charges": [{"minimum": 42.05, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC PRETX INCUBATJ W/ENZYMES", "code_information": [{"code": "86971", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC SED RATE AUTOMATED", "code_information": [{"code": "85652", "type": "CPT"}], "standard_charges": [{"minimum": 3.11, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX ID DILUTION", "code_information": [{"code": "86976", "type": "CPT"}], "standard_charges": [{"minimum": 36.05, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX INCUBJ DRUGS", "code_information": [{"code": "86975", "type": "CPT"}], "standard_charges": [{"minimum": 32.51, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX INCUBJ/INHIB", "code_information": [{"code": "86977", "type": "CPT"}], "standard_charges": [{"minimum": 36.05, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC, FRZ/DEG/WSH, L/R, IRRAD", "code_information": [{"code": "P9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC, L/R, CMV-NEG, IRRAD", "code_information": [{"code": "P9058", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96931", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96932", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96933", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96934", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96935", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96936", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RCMND FLW-UP 10 YRS DOCD", "code_information": [{"code": "528F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RE-CEMENT OR RE-BOND CROWN", "code_information": [{"code": "D2920", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RE-EVAL POST-OP VISIT", "code_information": [{"code": "D0171", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RE-EVAL,EST PT,PROBLEM FOCUS", "code_information": [{"code": "D0170", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORATION OF CHEST", "code_information": [{"code": "32120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORE PARATHYROIDS", "code_information": [{"code": "60502", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REACHING/GRABBING DEVICE", "code_information": [{"code": "A9281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "READY GRADIENT GAUNTLET", "code_information": [{"code": "S8428", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "READY GRADIENT GLOVE", "code_information": [{"code": "S8427", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "READY GRADIENT SLEEV/GLOV", "code_information": [{"code": "S8421", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "READY GRADIENT SLEEVE", "code_information": [{"code": "S8424", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF HAND", "code_information": [{"code": "25335", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27455", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27457", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF LOWER LEG", "code_information": [{"code": "27712", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF TENDONS", "code_information": [{"code": "26437", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF THIGH BONE", "code_information": [{"code": "27454", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REAS NO ADHERE THERAPY", "code_information": [{"code": "G8854", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REATTACH TOOTH FRAGMENT", "code_information": [{"code": "D2921", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBASE HYBRID PROSTHESIS", "code_information": [{"code": "D5725", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBOUND MATRIX, PER SQ CM", "code_information": [{"code": "Q4296", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69632", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69633", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69636", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69637", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69310", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69320", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REC CATH MAN PUMP ENEMA REPL", "code_information": [{"code": "A4453", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REC INST NO SMOKE DAY SURG", "code_information": [{"code": "G9497", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REC'D ESRD MCP LST DAY OF MO", "code_information": [{"code": "M1269", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECD 2 ANTI-EMET PRE/INTRAOP", "code_information": [{"code": "G9775", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECD SCRN HCV INFEC", "code_information": [{"code": "G9383", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEIVER/TRANSMITTER, NEURO", "code_information": [{"code": "C1816", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT CAST OR PREFAB POST", "code_information": [{"code": "D2915", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT FIXED RETAINER MAN", "code_information": [{"code": "D8699", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT FIXED RETAINER MAX", "code_information": [{"code": "D8698", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT INLAY ONLAY OR PART", "code_information": [{"code": "D2910", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT SPACE MAINT - MAN", "code_information": [{"code": "D1552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT SPACE MAINT - MAX", "code_information": [{"code": "D1551", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT SUPP CROWN", "code_information": [{"code": "D6092", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT SUPP PART DENTURE", "code_information": [{"code": "D6093", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT UNILAT SPACE MAINT", "code_information": [{"code": "D1553", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEMENT/BOND PART DENTURE", "code_information": [{"code": "D6930", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35301", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35302", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35303", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35304", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35306", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35311", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35321", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35331", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35341", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35351", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35355", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35361", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35363", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35371", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35372", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECIPROCATING PERITONEAL DIA", "code_information": [{"code": "E1630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECLAST 5MG/100ML INJ", "drug_information": {"unit": 5.0, "type": "EA"}, "code_information": [{"code": "J3489", "type": "HCPCS"}, {"code": "72000791", "type": "CDM"}, {"code": "00078043561", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 509.24, "maximum": 1903.68, "gross_charge": 2115.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1586.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1692.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1903.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1205.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECON, CTA FOR SURG PLAN", "code_information": [{"code": "G0288", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/FIXATION", "code_information": [{"code": "21196", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/GRAFT", "code_information": [{"code": "21194", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O FIXATION", "code_information": [{"code": "21195", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O GRAFT", "code_information": [{"code": "21193", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW SEGMENT", "code_information": [{"code": "21198", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW W/ADVANCE", "code_information": [{"code": "21199", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ANKLE JOINT", "code_information": [{"code": "27702", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT BRONCHUS", "code_information": [{"code": "31775", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT FOOT", "code_information": [{"code": "28360", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42200", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42205", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42210", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42215", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42220", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42225", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21182", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21183", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21184", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24360", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24361", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24362", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW LAT LIGMNT", "code_information": [{"code": "24344", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW MED LIGMNT", "code_information": [{"code": "24346", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21179", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21180", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT EXTRA FINGER", "code_information": [{"code": "26587", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26545", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26548", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24365", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24366", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT INJURED CHEST", "code_information": [{"code": "32820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LARYNX & PHARYNX", "code_information": [{"code": "31395", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40525", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40527", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21247", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21255", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MAXILLA SEGMENT", "code_information": [{"code": "D7947", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MIDFACE NO GRAFT", "code_information": [{"code": "D7948", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MIDFACE W/GRAFT", "code_information": [{"code": "D7949", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21172", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21175", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHOULDER JOINT", "code_information": [{"code": "23470", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHOULDER JOINT", "code_information": [{"code": "23472", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ULNA/RADIOULNAR", "code_information": [{"code": "25337", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT UPPER JAW BONE", "code_information": [{"code": "21206", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 1", "code_information": [{"code": "53420", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 2", "code_information": [{"code": "53425", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA/BLADDER", "code_information": [{"code": "53431", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT VENA CAVA", "code_information": [{"code": "34502", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31780", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31781", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25441", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25442", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25443", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25444", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25445", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION ANKLE JOINT", "code_information": [{"code": "27703", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27427", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27428", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27429", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MAXILLA TOTAL", "code_information": [{"code": "D7946", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ANUS", "code_information": [{"code": "46753", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF BILE DUCTS", "code_information": [{"code": "47800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21120", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21121", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21122", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21123", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67971", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67973", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67974", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67975", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27122", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21245", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21246", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21248", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21249", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21240", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21242", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21243", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF LOWER JAW", "code_information": [{"code": "21244", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MIDFACE", "code_information": [{"code": "21188", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40840", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40842", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40843", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40844", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40845", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NAIL BED", "code_information": [{"code": "11762", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30400", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30410", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30420", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ORBIT", "code_information": [{"code": "21256", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF PYLORUS", "code_information": [{"code": "43800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF STERNUM", "code_information": [{"code": "21740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF THROAT", "code_information": [{"code": "42950", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53410", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53415", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53430", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54308", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54312", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54316", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54318", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54322", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54324", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54326", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF WINDPIPE", "code_information": [{"code": "31766", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION TONGUE FOLD", "code_information": [{"code": "41520", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECORD BP IP, ER, URG/SELF", "code_information": [{"code": "G9789", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECTAL EXAM IN PT ROOM", "code_information": [{"code": "46999", "type": "CPT"}, {"code": "11000075", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1214.06, "maximum": 4701.37, "gross_charge": 2129.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1597.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1703.95, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1916.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1214.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH CC", "code_information": [{"code": "333", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH MCC", "code_information": [{"code": "332", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITHOUT CC/MCC", "code_information": [{"code": "334", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RECTAL SENSATION TEST", "code_information": [{"code": "91120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [{"code": "811", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 4488.26, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [{"code": "812", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELLS UNIT", "code_information": [{"code": "P9021", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS MULTIPLE", "code_information": [{"code": "78121", "type": "CPT"}], "standard_charges": [{"minimum": 98.0, "maximum": 98.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS SINGLE", "code_information": [{"code": "78120", "type": "CPT"}], "standard_charges": [{"minimum": 89.23, "maximum": 89.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 89.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RED CELL SEQUESTRATION", "code_information": [{"code": "78140", "type": "CPT"}], "standard_charges": [{"minimum": 139.76, "maximum": 3077.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 139.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3077.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RED CELL SURVIVAL STUDY", "code_information": [{"code": "78130", "type": "CPT"}], "standard_charges": [{"minimum": 157.2, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RED DOTS ADULT", "code_information": [{"code": "3000039", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RED DOTS PEDIATRIC", "code_information": [{"code": "3000171", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REDO COMPL CARDIAC ANOMALY", "code_information": [{"code": "33622", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDO ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37192", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCE BOWEL OBSTRUCTION", "code_information": [{"code": "44050", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCE TESTIS TORSION", "code_information": [{"code": "54600", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCT COMPND FACIAL BONE FX", "code_information": [{"code": "D7780", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCT SIMPLE FACIAL BONE FX", "code_information": [{"code": "D7680", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FACIAL BONES", "code_information": [{"code": "21209", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21137", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21138", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21139", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF RECTAL PROLAPSE", "code_information": [{"code": "45900", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62115", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62117", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REEXPLORATION PELVIC WOUND", "code_information": [{"code": "49014", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REF FOR OTO EVAL", "code_information": [{"code": "G8856", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REF TO OUTPT CARD REHAB PROG", "code_information": [{"code": "4500F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REF TO THERAPY", "code_information": [{"code": "G0042", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFERRED FOR AN AV FISTULA", "code_information": [{"code": "4051F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PORTABLE PUMP", "code_information": [{"code": "96521", "type": "CPT"}], "standard_charges": [{"minimum": 171.74, "maximum": 171.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 171.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PUMP/RESVR SYST", "code_information": [{"code": "96522", "type": "CPT"}], "standard_charges": [{"minimum": 151.42, "maximum": 151.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 151.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFITTING OF OBTURATOR", "code_information": [{"code": "D5933", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFRACT NOT +/- 1.0 W/IN 90D", "code_information": [{"code": "G9520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFRESH LACRILUBE OPTH OINT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000304", "type": "CDM"}, {"code": "00023031204", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G2209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9726", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9728", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9730", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9732", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9734", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFUSED TO PARTICIPATE", "code_information": [{"code": "G9736", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REGADENOSON INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2785", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REGIONAL BLOCK ANESTHESIA", "code_information": [{"code": "D9211", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.72, "maximum": 112.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REGLAN (METOCLOP) 10MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2765", "type": "HCPCS"}, {"code": "72000716", "type": "CDM"}, {"code": "00409341401", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGLAN (METOCLOPRAMIDE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000314", "type": "CDM"}, {"code": "00093220401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR H MLT INJ", "code_information": [{"code": "490T", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR HANDS", "code_information": [{"code": "489T", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REGUARD, TOPICAL USE PER SQ", "code_information": [{"code": "Q4255", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REHAB SUPPORT MSK CARE MVP", "code_information": [{"code": "M1370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REHAB THXPY OPTIONS W/PT", "code_information": [{"code": "4400F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REHABILITATION PROGRAM 1/2 D", "code_information": [{"code": "H2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 1009.51, "maximum": 1009.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1009.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITH CC/MCC", "code_information": [{"code": "945", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITHOUT CC/MCC", "code_information": [{"code": "946", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REIMPLANT ARTERY EACH", "code_information": [{"code": "35697", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50780", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50782", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50783", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50785", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANTATION OF KIDNEY", "code_information": [{"code": "50380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE CLAVICLE", "code_information": [{"code": "23490", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE EYE WALL", "code_information": [{"code": "67250", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE HIP BONES", "code_information": [{"code": "27187", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE HUMERUS", "code_information": [{"code": "24498", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE PULMONARY ARTERY", "code_information": [{"code": "33690", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS", "code_information": [{"code": "25490", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS AND ULNA", "code_information": [{"code": "25492", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE SHOULDER BONES", "code_information": [{"code": "23491", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE THIGH", "code_information": [{"code": "27495", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE TIBIA", "code_information": [{"code": "27745", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE ULNA", "code_information": [{"code": "25491", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE/GRAFT EYE WALL", "code_information": [{"code": "67255", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINNERVATE LARYNX", "code_information": [{"code": "31590", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINSERT OCULAR IMPLANT", "code_information": [{"code": "65155", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINSERT SPINAL FIXATION", "code_information": [{"code": "22849", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELAFEN (NABUMETONE) 750MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002540", "type": "CDM"}, {"code": "69097096607", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RELAFEN (NABUMETONE) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000924", "type": "CDM"}, {"code": "50228046505", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RELEASE ENCIRCLING MATERIAL", "code_information": [{"code": "67115", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE EYE TISSUE", "code_information": [{"code": "67343", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69720", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69725", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69955", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE FINGER CONTRACTURE", "code_information": [{"code": "26525", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE FOOT/TOE NERVE", "code_information": [{"code": "64726", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE FOREARM/HAND TENDON", "code_information": [{"code": "26449", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE HAND/FINGER TENDON", "code_information": [{"code": "26445", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE INNER EAR CANAL", "code_information": [{"code": "69960", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE KNUCKLE CONTRACTURE", "code_information": [{"code": "26520", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE MIDDLE EAR BONE", "code_information": [{"code": "69650", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE MUSCLES OF HAND", "code_information": [{"code": "26593", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF BIG TOE", "code_information": [{"code": "28240", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF EYE FLUID", "code_information": [{"code": "67015", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT CONTRACTURE", "code_information": [{"code": "28270", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28220", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28225", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28222", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28226", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDON", "code_information": [{"code": "27680", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDONS", "code_information": [{"code": "27681", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LUNG", "code_information": [{"code": "32220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28260", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28264", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SHOULDER LIGAMENT", "code_information": [{"code": "23415", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61552", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF TOE JOINT EACH", "code_information": [{"code": "28272", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50715", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50722", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM & FINGER TENDON", "code_information": [{"code": "26442", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26040", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26045", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26121", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26123", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26125", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM/FINGER TENDON", "code_information": [{"code": "26440", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE SHOULDER JOINT", "code_information": [{"code": "23020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE SPINAL CORD LUMBAR", "code_information": [{"code": "63200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE THUMB CONTRACTURE", "code_information": [{"code": "26508", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE WRIST/FOREARM TENDON", "code_information": [{"code": "25295", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE/REVISE URETER", "code_information": [{"code": "50725", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELESE, PER SQ CM", "code_information": [{"code": "Q4257", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELIEVE BLADDER CONTRACTURE", "code_information": [{"code": "52640", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELIEVE CRANIAL PRESSURE", "code_information": [{"code": "61345", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELIEVE INNER EYE PRESSURE", "code_information": [{"code": "65820", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELIEVE PRESSURE ON NERVE(S)", "code_information": [{"code": "64722", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELINE SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9953", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELISTOR 12MG/0.6ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2212", "type": "HCPCS"}, {"code": "72000942", "type": "CDM"}, {"code": "65649055107", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 181.85, "maximum": 287.14, "gross_charge": 319.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 239.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 255.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 287.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 181.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOC SKIN POCKET PLS GEN", "code_information": [{"code": "416T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELOCATE POCKET FOR DEFIB", "code_information": [{"code": "33223", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELOCATION OF TESTIS(ES)", "code_information": [{"code": "54680", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELOCATION POCKET PACEMAKER", "code_information": [{"code": "33222", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEVICE W/FLAP", "code_information": [{"code": "D7299", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM AUTON ALG NSLN CAL SETUP", "code_information": [{"code": "740T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM AUTON ALG NSLN DATA COLL", "code_information": [{"code": "741T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM ENDOVAS VENA CAVA FILTER", "code_information": [{"code": "37193", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM EXOSTOSIS ANY SITE", "code_information": [{"code": "D7471", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM FIXED UNILAT SPACE MAINT", "code_information": [{"code": "D1556", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM IMP TOOTH W MUCOPER FLP", "code_information": [{"code": "D7210", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL ICPMS", "code_information": [{"code": "93297", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL SCRMS", "code_information": [{"code": "93298", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS PHYS", "code_information": [{"code": "578T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS TECH", "code_information": [{"code": "579T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/IDS", "code_information": [{"code": "93296", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/LDLS PM", "code_information": [{"code": "93294", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM MLT DAY UROFLOW DEV SPLY", "code_information": [{"code": "812T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM MLT DAY UROFLOW SETUP", "code_information": [{"code": "811T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM DEV", "code_information": [{"code": "99454", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM SETUP", "code_information": [{"code": "99453", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR ALYS", "code_information": [{"code": "608T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR SETUP", "code_information": [{"code": "607T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM MNTR WRLS P-ART PRS SNR", "code_information": [{"code": "93264", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM NONODONTO CYST > 1.25 CM", "code_information": [{"code": "D7461", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM NONODONTO CYST TO 1.25CM", "code_information": [{"code": "D7460", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA DEV SETUP&EDUCAJ", "code_information": [{"code": "604T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA PHYS/QHP EA 30D", "code_information": [{"code": "606T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA TECHL SPRT MIN 8", "code_information": [{"code": "605T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM ODONTOGEN CYST > 1.25 CM", "code_information": [{"code": "D7451", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM ODONTOGEN CYST TO 1.25CM", "code_information": [{"code": "D7450", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR 1ST 20 MIN", "code_information": [{"code": "99457", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR EA ADDL 20", "code_information": [{"code": "99458", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM R-T MTN NREHAB THER SPLY", "code_information": [{"code": "733T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM R-T MTN NREHAB TX MGMT", "code_information": [{"code": "734T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST 20 MIN", "code_information": [{"code": "98980", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST SETUP&EDU", "code_information": [{"code": "98975", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY CBT", "code_information": [{"code": "98978", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY RESP", "code_information": [{"code": "98976", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DV SPLY MSCSKL", "code_information": [{"code": "98977", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR EA ADDL 20 MIN", "code_information": [{"code": "98981", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA I&R PHY/QHP", "code_information": [{"code": "706T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA SETUP&EDU", "code_information": [{"code": "704T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA TECH SPRT", "code_information": [{"code": "705T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM UNILAT DENT 1 PC RESIN", "code_information": [{"code": "D5286", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REM UNILAT DENT FLEX BASE", "code_information": [{"code": "D5284", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMDESIVIR 100MG VIAL/ 100ML 0.9% NS", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J0248", "type": "HCPCS"}, {"code": "72001099", "type": "CDM"}, {"code": "61958290101", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 906.3, "maximum": 1431.0, "gross_charge": 1590.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1192.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1272.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 906.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMERON (MIRTAZAPINE) TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000353", "type": "CDM"}, {"code": "13107003134", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REMERON (MIRTAZAPINE) TAB 45MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000187", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 9.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REMINYL (GALANTAMINE HYDROBR) TAB 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000405", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REMIS12M NOT PHQ-9 SCORE <5", "code_information": [{"code": "G9510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOT IMAGE SUBMIT BY PT", "code_information": [{"code": "G2010", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOT IMG SUB BY PT, NON E/M", "code_information": [{"code": "G2250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93228", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG TECH SUPP", "code_information": [{"code": "93229", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT  15MINS", "code_information": [{"code": "G9984", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 10MINS", "code_information": [{"code": "G9486", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 10MINS", "code_information": [{"code": "G9983", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 15MINS", "code_information": [{"code": "G9487", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 25MINS", "code_information": [{"code": "G9488", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 25MINS", "code_information": [{"code": "G9985", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 40MINS", "code_information": [{"code": "G9489", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M EST. PT 40MINS", "code_information": [{"code": "G9986", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 10MINS", "code_information": [{"code": "G9481", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 10MINS", "code_information": [{"code": "G9978", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 20MINS", "code_information": [{"code": "G9482", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 20MINS", "code_information": [{"code": "G9979", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 30 MINS", "code_information": [{"code": "G9980", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 30MINS", "code_information": [{"code": "G9483", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 45MINS", "code_information": [{"code": "G9484", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 45MINS", "code_information": [{"code": "G9981", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 60MINS", "code_information": [{"code": "G9485", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 60MINS", "code_information": [{"code": "G9982", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY LMBR/SAC", "code_information": [{"code": "63307", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY THRCLMBR", "code_information": [{"code": "63306", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV VERT XDRL BDY LMBR/SAC", "code_information": [{"code": "63303", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV VERTBR DCMPRN THRCLMBR", "code_information": [{"code": "63087", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC PENIS PROS COMP", "code_information": [{"code": "54411", "type": "CPT"}], "standard_charges": [{"minimum": 43844.82, "maximum": 43844.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 43844.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC UR SPHINCTR COMP", "code_information": [{"code": "53448", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVABLE PROSTHODONTIC PROC", "code_information": [{"code": "D5899", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVABLE RETAINER ADJUST", "code_information": [{"code": "D8681", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL ABDOMEN LYMPH NODES", "code_information": [{"code": "38564", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL ALLOGRAFT PANCREAS", "code_information": [{"code": "48556", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL ANTERIOR INSTRMJ", "code_information": [{"code": "22855", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL BILIARY DRG CATH", "code_information": [{"code": "47537", "type": "CPT"}], "standard_charges": [{"minimum": 637.4, "maximum": 637.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 637.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL COMPLETE IIMS", "code_information": [{"code": "530T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL DUCT GLBLDR CALCULI", "code_information": [{"code": "47544", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB EAR CANAL TECH", "code_information": [{"code": "69200", "type": "CPT"}, {"code": "11000077", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "estimated_discounted_cash": 315.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB MOUTH TECH", "code_information": [{"code": "40804", "type": "CPT"}, {"code": "11000079", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1271.36, "maximum": 2007.42, "gross_charge": 2230.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1784.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2007.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1271.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB SKIN/AREOLAR TISS", "code_information": [{"code": "D7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB SUBUTANEOUS TISSUE COMP TECH", "code_information": [{"code": "10121", "type": "CPT"}, {"code": "11000081", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1422.05, "maximum": 3558.68, "gross_charge": 3954.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2965.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3163.27, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 3558.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2253.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB SUBUTANEOUS TISSUE SIMPLE TEC", "code_information": [{"code": "10120", "type": "CPT"}, {"code": "11000083", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 358.5, "maximum": 566.05, "gross_charge": 628.95, "discounted_cash": 54.17, "estimated_discounted_cash": 628.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 471.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 503.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 566.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 358.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB-EYE SUPRF (TECH)", "code_information": [{"code": "65205", "type": "CPT"}, {"code": "11000084", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "estimated_discounted_cash": 315.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB-FOOT-COMP (TECH)", "code_information": [{"code": "28193", "type": "CPT"}, {"code": "11000085", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 2305.13, "maximum": 3667.07, "gross_charge": 4044.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3033.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3235.27, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 3639.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2305.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB-FOOT-DEEP (TECH)", "code_information": [{"code": "28192", "type": "CPT"}, {"code": "11000086", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 2305.13, "maximum": 3667.07, "gross_charge": 4044.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3033.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3235.27, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 3639.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2305.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB-FOOT-SUPRF (TECH)", "code_information": [{"code": "28190", "type": "CPT"}, {"code": "11000087", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 997.97, "maximum": 1575.74, "gross_charge": 1750.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1313.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1400.66, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1575.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 997.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB-NOSE (TECH)", "code_information": [{"code": "30300", "type": "CPT"}, {"code": "11000088", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB-THROAT (TECH)", "code_information": [{"code": "42809", "type": "CPT"}, {"code": "11000089", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 852.55, "maximum": 1346.13, "gross_charge": 1495.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1121.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1196.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1346.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 852.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY GUM", "code_information": [{"code": "41805", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY JAWBONE", "code_information": [{"code": "41806", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40805", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS ELECTRODE ONLY", "code_information": [{"code": "531T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS IMPLT MNTR ONLY", "code_information": [{"code": "532T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPACT CERUMEN IRRIGATION", "code_information": [{"code": "69209", "type": "CPT"}, {"code": "11000290", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 95.69, "maximum": 151.09, "gross_charge": 167.88, "discounted_cash": 54.17, "estimated_discounted_cash": 167.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 151.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 95.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPACT CERUMEN TECH", "code_information": [{"code": "69210", "type": "CPT"}, {"code": "11000090", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 95.69, "maximum": 151.09, "gross_charge": 167.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 151.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 95.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANT SUPERFICIAL", "code_information": [{"code": "20670", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN COMPLEX", "code_information": [{"code": "50225", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN RADICAL", "code_information": [{"code": "50230", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38550", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38555", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42830", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42831", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42835", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42836", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL FISSURE", "code_information": [{"code": "46200", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL TAGS", "code_information": [{"code": "46230", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE BONE", "code_information": [{"code": "28130", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE IMPLANT", "code_information": [{"code": "27704", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE/HEEL LESION", "code_information": [{"code": "28100", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANORECTAL LESION", "code_information": [{"code": "45108", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARM ARTERY CLOT", "code_information": [{"code": "34111", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34051", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34201", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER", "code_information": [{"code": "51570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51575", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51585", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER CYST", "code_information": [{"code": "51500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51525", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER STONE", "code_information": [{"code": "51050", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE FOR GRAFT", "code_information": [{"code": "20900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE FOR GRAFT", "code_information": [{"code": "20902", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23146", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61514", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61522", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61516", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61518", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61521", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61524", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61526", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61534", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61536", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61537", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61538", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61539", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61543", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61566", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BREAST LESION", "code_information": [{"code": "19120", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BREAST TISSUE", "code_information": [{"code": "19300", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BROW WRINKLES", "code_information": [{"code": "15826", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CALCIUM DEPOSITS", "code_information": [{"code": "23000", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX", "code_information": [{"code": "57530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX RADICAL", "code_information": [{"code": "57531", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CHEST LINING", "code_information": [{"code": "32310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35875", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35876", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLLAR BONE", "code_information": [{"code": "23125", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44156", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART", "code_information": [{"code": "33940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART/LUNG", "code_information": [{"code": "33930", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR LIVER", "code_information": [{"code": "47133", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54860", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54861", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIGLOTTIS", "code_information": [{"code": "31420", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43107", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43108", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43113", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43124", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31200", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31201", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31205", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EXTERNAL EAR", "code_information": [{"code": "69120", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65101", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65110", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65400", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65420", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65426", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FACE WRINKLES", "code_information": [{"code": "15828", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FALLOPIAN TUBE", "code_information": [{"code": "58700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FB ARM/ELBOW (TECH)", "code_information": [{"code": "24200", "type": "CPT"}, {"code": "11000092", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1422.05, "maximum": 3639.68, "gross_charge": 4044.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3033.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3235.27, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 3639.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2305.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FB HAND/FINGER COMP(TECH)", "code_information": [{"code": "20525", "type": "CPT"}, {"code": "11000094", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1422.05, "maximum": 6277.14, "gross_charge": 6974.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5230.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 5579.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 6277.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 3975.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FB HAND/FINGER SIMPLE(TECH)", "code_information": [{"code": "20520", "type": "CPT"}, {"code": "11000097", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1422.05, "maximum": 3639.68, "gross_charge": 4044.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3033.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3235.27, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 3639.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2305.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FB REACTION", "code_information": [{"code": "D7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER LESION", "code_information": [{"code": "26210", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER TENDON", "code_information": [{"code": "26180", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FASCIA", "code_information": [{"code": "28062", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28070", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28072", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28080", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28090", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28104", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREARM LESION", "code_information": [{"code": "25120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREHEAD WRINKLES", "code_information": [{"code": "15824", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "27372", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31080", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31081", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31084", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31085", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31086", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31087", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47612", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GUM TISSUE", "code_information": [{"code": "41830", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEAD OF HUMERUS", "code_information": [{"code": "23195", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33542", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL BONE", "code_information": [{"code": "28118", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL SPUR", "code_information": [{"code": "28119", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEMORRHOID CLOT", "code_information": [{"code": "46320", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP JOINT LINING", "code_information": [{"code": "27054", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27090", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27091", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23156", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELE", "code_information": [{"code": "55040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELE", "code_information": [{"code": "55500", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELES", "code_information": [{"code": "55041", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPACTED WAX MD", "code_information": [{"code": "G0268", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT DEEP", "code_information": [{"code": "20680", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT FROM HAND", "code_information": [{"code": "26320", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INFUSION PUMP", "code_information": [{"code": "36262", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE FLUID", "code_information": [{"code": "67036", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE LESION", "code_information": [{"code": "66770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30117", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30118", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66625", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66630", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66635", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ISCHIAL BURSA", "code_information": [{"code": "27060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW BONE LESION", "code_information": [{"code": "21044", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW JOINT", "code_information": [{"code": "21050", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY", "code_information": [{"code": "50340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50234", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50236", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50290", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27332", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27333", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CYST", "code_information": [{"code": "27345", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE PROSTHESIS", "code_information": [{"code": "27488", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP", "code_information": [{"code": "27350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP BURSA", "code_information": [{"code": "27340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31360", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31365", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX & PHARYNX", "code_information": [{"code": "31390", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31300", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31512", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEFT HEART VENT", "code_information": [{"code": "33989", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG ARTERY CLOT", "code_information": [{"code": "34203", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG VEINS/LESION", "code_information": [{"code": "37735", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS LESION", "code_information": [{"code": "66830", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66840", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66850", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66852", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG EXTRAPLEURAL", "code_information": [{"code": "32445", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION", "code_information": [{"code": "32540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38700", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38720", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38724", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL", "code_information": [{"code": "28140", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL HEADS", "code_information": [{"code": "28114", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NECK WRINKLES", "code_information": [{"code": "15825", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64790", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64792", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE", "code_information": [{"code": "30160", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30124", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30125", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30110", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30115", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OCULAR IMPLANT", "code_information": [{"code": "65175", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OMENTUM", "code_information": [{"code": "49255", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARIAN CYST(S)", "code_information": [{"code": "58925", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58943", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY/TUBE(S)", "code_information": [{"code": "58720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PACEMAKER SYSTEM", "code_information": [{"code": "33234", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PALM TENDON EACH", "code_information": [{"code": "26170", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS", "code_information": [{"code": "48155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS LESION", "code_information": [{"code": "48120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC DUCT", "code_information": [{"code": "48148", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC STONE", "code_information": [{"code": "48020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIC STRUCTURES", "code_information": [{"code": "51597", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIS CONTENTS", "code_information": [{"code": "58240", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PENIS", "code_information": [{"code": "54125", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61546", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61548", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PM GENERATOR", "code_information": [{"code": "33233", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55801", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55821", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55831", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTAL MARKER", "code_information": [{"code": "46030", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45112", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM AND COLON", "code_information": [{"code": "45121", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB", "code_information": [{"code": "21615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB AND NERVES", "code_information": [{"code": "21616", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB(S)", "code_information": [{"code": "32900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42330", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42335", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42340", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM", "code_information": [{"code": "55150", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM LESION", "code_information": [{"code": "55120", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SESAMOID BONE", "code_information": [{"code": "28315", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SHUNT", "code_information": [{"code": "49429", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKIN WRINKLES", "code_information": [{"code": "15829", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKULL LESION", "code_information": [{"code": "61500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SLOUGHED OFF BONE", "code_information": [{"code": "D7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44121", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44125", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPERM CORD LESION", "code_information": [{"code": "55520", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPERM DUCT(S)", "code_information": [{"code": "55250", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL SHUNT", "code_information": [{"code": "63746", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN PARTIAL", "code_information": [{"code": "38101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43621", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43622", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43631", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43632", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43633", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43634", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43635", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURE FROM ANUS", "code_information": [{"code": "46754", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURES", "code_information": [{"code": "S0630", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE", "code_information": [{"code": "27080", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15920", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR GLAND", "code_information": [{"code": "68500", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR SAC", "code_information": [{"code": "68520", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON FOR GRAFT", "code_information": [{"code": "20924", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON LESION", "code_information": [{"code": "27630", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54520", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54530", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60520", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60521", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60522", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60240", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60252", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60271", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TMJ CONDYLE", "code_information": [{"code": "D7840", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE", "code_information": [{"code": "28150", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIONS", "code_information": [{"code": "28092", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIONS", "code_information": [{"code": "28108", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONGUE", "code_information": [{"code": "41140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42825", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42826", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TORUS PALATINUS", "code_information": [{"code": "D7472", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31225", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31230", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50630", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "51060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53210", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53215", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53250", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53270", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53230", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53235", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34401", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34421", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34451", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34471", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34490", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BONE", "code_information": [{"code": "25210", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BONES", "code_information": [{"code": "25215", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST LESION", "code_information": [{"code": "25130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25251", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL PACEMAKER ELECTRODE", "code_information": [{"code": "33235", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL PELVIC LYMPH NODES", "code_information": [{"code": "38562", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL PROSTH RADIAL HEAD", "code_information": [{"code": "24164", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL PULSE GEN ONLY ISDSS", "code_information": [{"code": "682T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL SKIN TAGS (TECH)", "code_information": [{"code": "11200", "type": "CPT"}, {"code": "11000105", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL SS DFB ELECTRODE", "code_information": [{"code": "573T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPLE REQ ANES", "code_information": [{"code": "15851", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV CATH", "code_information": [{"code": "36589", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV CATH", "code_information": [{"code": "36590", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29710", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25136", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE & TREAT BRAIN LESION", "code_information": [{"code": "61544", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMEN LYMPH NODES", "code_information": [{"code": "38780", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMINAL LYMPH NODES", "code_information": [{"code": "38747", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST 2 STAGE", "code_information": [{"code": "46285", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST COMPLEX", "code_information": [{"code": "46280", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST INTER", "code_information": [{"code": "46275", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST SUBQ", "code_information": [{"code": "46270", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANEURYSM SINUS", "code_information": [{"code": "61613", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27625", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27626", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33851", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTIC ASSIST DEVICE", "code_information": [{"code": "33968", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38740", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38745", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BILAT SPACE MAIN, MAN", "code_information": [{"code": "D1527", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BILAT SPACE MAIN, MAX", "code_information": [{"code": "D1526", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52317", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52318", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/CREATE POUCH", "code_information": [{"code": "51596", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51580", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51590", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51595", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLOOD CLOT FROM EYE", "code_information": [{"code": "65930", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CANAL FLUID", "code_information": [{"code": "61050", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY FLUID", "code_information": [{"code": "61020", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY SHUNT", "code_information": [{"code": "62256", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN ELECTRODES", "code_information": [{"code": "61535", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61512", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61519", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN TUMOR W/SCOPE", "code_information": [{"code": "62164", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BROKEN IMP RET SCREW", "code_information": [{"code": "D6096", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20910", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20912", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CERCLAGE SUTURE", "code_information": [{"code": "59871", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX REPAIR BOWEL", "code_information": [{"code": "57556", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR PELVIS", "code_information": [{"code": "57545", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR VAGINA", "code_information": [{"code": "57555", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23170", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23180", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLOID CYST W/SCOPE", "code_information": [{"code": "62162", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CONTRACEPTIVE CAPSULE", "code_information": [{"code": "11976", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CORONOID PROCESS", "code_information": [{"code": "21070", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61000", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61001", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA DEVICE OBSTRUCT", "code_information": [{"code": "75901", "type": "CPT"}], "standard_charges": [{"minimum": 300.53, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 300.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA LUMEN OBSTRUCT", "code_information": [{"code": "75902", "type": "CPT"}], "standard_charges": [{"minimum": 118.69, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 118.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE DIGIT NERVE LESION", "code_information": [{"code": "64776", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT", "code_information": [{"code": "G0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT DEVICE", "code_information": [{"code": "11982", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69140", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69145", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69540", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69550", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69552", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69554", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELCTRD TRANSVENOUSLY", "code_information": [{"code": "33244", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33236", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33237", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33238", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELTRD/THORACOTOMY", "code_information": [{"code": "33243", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EPIDIDYMIS LESION", "code_information": [{"code": "54830", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EPIDIDYMIS LESION", "code_information": [{"code": "54840", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ESOPHAGUS OBSTRUCTION", "code_information": [{"code": "74235", "type": "CPT"}], "standard_charges": [{"minimum": 206.96, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 206.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MANDIBLE", "code_information": [{"code": "21031", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MAXILLA", "code_information": [{"code": "21032", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EXT HEM GROUPS 2+", "code_information": [{"code": "46250", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTERNAL EAR PARTIAL", "code_information": [{"code": "69110", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22103", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22116", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67120", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67121", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "65900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "66130", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/ATTACH IMPLANT", "code_information": [{"code": "65105", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/INSERT IMPLANT", "code_information": [{"code": "65103", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65112", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65114", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID FOREIGN BODY", "code_information": [{"code": "67938", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION", "code_information": [{"code": "67800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION", "code_information": [{"code": "67840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION(S)", "code_information": [{"code": "67808", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67801", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67805", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68110", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68115", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68130", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68135", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION", "code_information": [{"code": "27355", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/BURSA", "code_information": [{"code": "27062", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/FIXATION", "code_information": [{"code": "27358", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27356", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27357", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FINGER BONE", "code_information": [{"code": "26185", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FIXED BILAT MAINT MAX", "code_information": [{"code": "D1557", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FIXED BILAT MAN", "code_information": [{"code": "D1558", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FIXED ORTHO APPLIANCE", "code_information": [{"code": "D8695", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.45, "maximum": 7500.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7500.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM BONE LESION", "code_information": [{"code": "25145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM FOREIGN BODY", "code_information": [{"code": "25248", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY ADBOMEN", "code_information": [{"code": "49402", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY BRAIN", "code_information": [{"code": "61570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65210", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65222", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65235", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65260", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65265", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY LARYNX", "code_information": [{"code": "31511", "type": "CPT"}], "standard_charges": [{"minimum": 2426.21, "maximum": 2426.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2426.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE GASTRIC PORT OPEN", "code_information": [{"code": "43887", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38760", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38765", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HAND BONE LESION", "code_information": [{"code": "26200", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES DEEP", "code_information": [{"code": "27066", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES SUPER", "code_information": [{"code": "27065", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27086", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27087", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15940", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15941", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15944", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15945", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15946", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23174", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23184", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT BODY", "code_information": [{"code": "D6105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT OF EYE", "code_information": [{"code": "65920", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GROUPS 2+", "code_information": [{"code": "46260", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP & FISS", "code_information": [{"code": "46257", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP W/FISTU", "code_information": [{"code": "46258", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS & FISS", "code_information": [{"code": "46261", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS W/FIST", "code_information": [{"code": "46262", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INFECTED SKULL BONE", "code_information": [{"code": "61501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR", "code_information": [{"code": "69905", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR & MASTOID", "code_information": [{"code": "69910", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INT/EXT HEM 1 GROUP", "code_information": [{"code": "46255", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTERIM IMPLANT", "code_information": [{"code": "D6198", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRAUTERINE DEVICE", "code_information": [{"code": "58301", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE IRIS AND LESION", "code_information": [{"code": "66600", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE CYST", "code_information": [{"code": "27347", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27334", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27335", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LAMINA/FACETS LUMBAR", "code_information": [{"code": "63012", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LIMB NERVE LESION", "code_information": [{"code": "64782", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LOWER LEG BONE LESION", "code_information": [{"code": "27635", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUMB ARTIF DISC ADDL", "code_information": [{"code": "164T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33910", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33915", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG CATHETER", "code_information": [{"code": "32552", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG FOREIGN BODY", "code_information": [{"code": "32151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG PNEUMONECTOMY", "code_information": [{"code": "32440", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE MANDIBLE CYST COMPLEX", "code_information": [{"code": "21046", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID AIR CELLS", "code_information": [{"code": "69670", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID STRUCTURES", "code_information": [{"code": "69505", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE MAXILLA CYST COMPLEX", "code_information": [{"code": "21048", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE MIDDLE EAR NERVE", "code_information": [{"code": "69676", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE MUTI-COMP PENIS PROS", "code_information": [{"code": "54406", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "11732", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30310", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30320", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE NERVE LESION", "code_information": [{"code": "64784", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE NON-RESORB BARRIER", "code_information": [{"code": "D4286", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PALATE/LESION", "code_information": [{"code": "42120", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22114", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF TEMPORAL BONE", "code_information": [{"code": "69535", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22112", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PELVIS LYMPH NODES", "code_information": [{"code": "38770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST COMPL", "code_information": [{"code": "11772", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST EXTEN", "code_information": [{"code": "11771", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST SIMPLE", "code_information": [{"code": "11770", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PITUIT TUMOR W/SCOPE", "code_information": [{"code": "62165", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PROSTATE REGROWTH", "code_information": [{"code": "52630", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PULMONARY SHUNT", "code_information": [{"code": "33924", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PULSE GENERATOR", "code_information": [{"code": "33241", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTAL OBSTRUCTION", "code_information": [{"code": "45915", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTUM W/RESERVOIR", "code_information": [{"code": "45119", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE RENAL TUBE W/FLUORO", "code_information": [{"code": "50389", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE REVISE CAST ARM/LEG TECH", "code_information": [{"code": "29705", "type": "CPT"}, {"code": "11000106", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 138.66, "maximum": 640.65, "gross_charge": 711.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 533.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 569.47, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 640.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 405.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE REVISE CAST BOOT/BODY TECH", "code_information": [{"code": "29700", "type": "CPT"}, {"code": "11000109", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 138.66, "maximum": 640.65, "gross_charge": 711.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 533.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 569.47, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 640.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 405.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15931", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15933", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15934", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15935", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15936", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15937", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SCIATIC NERVE LESION", "code_information": [{"code": "64786", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SCREW RETAINED PLATE", "code_information": [{"code": "D7298", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SELF-CONTD PENIS PROS", "code_information": [{"code": "54415", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23172", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23182", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BONE PART", "code_information": [{"code": "23130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FB DEEP", "code_information": [{"code": "23333", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FOREIGN BODY", "code_information": [{"code": "23330", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER JOINT LINING", "code_information": [{"code": "23105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SKIN NERVE LESION", "code_information": [{"code": "64774", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SKIN NERVE LESION", "code_information": [{"code": "64788", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM DUCT POUCH", "code_information": [{"code": "55650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM POUCH LESION", "code_information": [{"code": "55680", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CANAL CATHETER", "code_information": [{"code": "62355", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CORD LESION", "code_information": [{"code": "63600", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE ELTRD PERQ ARAY", "code_information": [{"code": "63661", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE ELTRD PLATE", "code_information": [{"code": "63662", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE FIXATION DEVICE", "code_information": [{"code": "22850", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE FIXATION DEVICE", "code_information": [{"code": "22852", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE INFUSION DEVICE", "code_information": [{"code": "62365", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 CRVL", "code_information": [{"code": "63001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 LMBR", "code_information": [{"code": "63005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 SCRL", "code_information": [{"code": "63011", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 THRC", "code_information": [{"code": "63003", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 CRVCL", "code_information": [{"code": "63015", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 LMBR", "code_information": [{"code": "63017", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 THRC", "code_information": [{"code": "63016", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE STENT VIA TRANSURETH", "code_information": [{"code": "50386", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64804", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64809", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64818", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64821", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64822", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68540", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68550", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TENDON SHEATH LESION", "code_information": [{"code": "26160", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15950", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15951", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15952", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15953", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15956", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15958", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THORACIC LYMPH NODES", "code_information": [{"code": "38746", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60280", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60281", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID LESION", "code_information": [{"code": "60200", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42820", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42821", "type": "CPT"}], "standard_charges": [{"minimum": 6376.32, "maximum": 6376.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6376.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TORUS MANDIBULARIS", "code_information": [{"code": "D7473", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TRANSPLANTED KIDNEY", "code_information": [{"code": "50370", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TUNNELED IP CATH", "code_information": [{"code": "49422", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE UNIL PART DENTURE,MAN", "code_information": [{"code": "D5283", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE UNIL PART DENTURE,MAX", "code_information": [{"code": "D5282", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE UNILAT SPACE MAINTAIN", "code_information": [{"code": "D1520", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER CALCULUS", "code_information": [{"code": "51065", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERCUT", "code_information": [{"code": "50384", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE URO SPHINCTER", "code_information": [{"code": "53446", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS AFTER CESAREAN", "code_information": [{"code": "59525", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS LESION", "code_information": [{"code": "59100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA GLAND LESION", "code_information": [{"code": "56740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA LESION", "code_information": [{"code": "57130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA LESION", "code_information": [{"code": "57135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE COMPL", "code_information": [{"code": "57111", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE PART", "code_information": [{"code": "57107", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL COMPLETE", "code_information": [{"code": "57110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL PARTIAL", "code_information": [{"code": "57106", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINAL FOREIGN BODY", "code_information": [{"code": "57415", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGUS N ELTRD", "code_information": [{"code": "64570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION SCOPE/GRAFT", "code_information": [{"code": "31546", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION W/SCOPE", "code_information": [{"code": "31545", "type": "CPT"}], "standard_charges": [{"minimum": 6212.1, "maximum": 6212.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6212.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTILATING TUBE", "code_information": [{"code": "69424", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33977", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33978", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN CRVL", "code_information": [{"code": "63081", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63090", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63085", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY CRVCL", "code_information": [{"code": "63304", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY THRC", "code_information": [{"code": "63305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY CRVCL", "code_information": [{"code": "63300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRC", "code_information": [{"code": "63301", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRLMB", "code_information": [{"code": "63302", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63082", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63086", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63088", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63091", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63103", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63308", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE W INSERT DRUG IMPLANT", "code_information": [{"code": "G0518", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31785", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31786", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT CARTILAGE", "code_information": [{"code": "25107", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT IMPLANT", "code_information": [{"code": "25449", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "25105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "26130", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST TENDON LESION", "code_information": [{"code": "25110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST TENDON LESION", "code_information": [{"code": "25111", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST/FOREARM LESION", "code_information": [{"code": "25115", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST/FOREARM LESION", "code_information": [{"code": "25116", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE&REPLACE PM GEN SINGL", "code_information": [{"code": "33227", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT BONE LESION", "code_information": [{"code": "26205", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FINGER LESION", "code_information": [{"code": "26215", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28102", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28103", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28106", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28107", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25125", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25126", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT HIP BONE LESION", "code_information": [{"code": "27067", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27637", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27638", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/INSERT DRUG IMPLANT", "code_information": [{"code": "11983", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPAIR HEARING AID", "code_information": [{"code": "69711", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE PENIS PROSTH", "code_information": [{"code": "54410", "type": "CPT"}], "standard_charges": [{"minimum": 43844.82, "maximum": 43844.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 43844.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE UR SPHINCTER", "code_information": [{"code": "53447", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/REVISE MALE SLING", "code_information": [{"code": "53442", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/TRANSPLANT TENDON", "code_information": [{"code": "23440", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE/TREAT LUNG LESIONS", "code_information": [{"code": "32141", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN DUAL LEAD", "code_information": [{"code": "33228", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN MULT LEADS", "code_information": [{"code": "33229", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMV/REPL PENIS CONTAIN PROS", "code_information": [{"code": "54416", "type": "CPT"}], "standard_charges": [{"minimum": 43844.82, "maximum": 43844.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 43844.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMV/REPLC PENIS PROS COMPL", "code_information": [{"code": "54417", "type": "CPT"}], "standard_charges": [{"minimum": 43844.82, "maximum": 43844.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 43844.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMVL INSJ IMPLTBL GLUC SENS", "code_information": [{"code": "448T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RENA VITE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001018", "type": "CDM"}, {"code": "00536730001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RENAL ABSCESS OPEN DRAIN", "code_information": [{"code": "50020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RENAL BIOPSY PERQ", "code_information": [{"code": "50200", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RENAL BX SURG EXPOSURE KDN", "code_information": [{"code": "50205", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH CC", "code_information": [{"code": "683", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH MCC", "code_information": [{"code": "682", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 4256.35, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITHOUT CC/MCC", "code_information": [{"code": "684", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RENAL PANEL", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "1000364", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.98, "maximum": 46.25, "gross_charge": 51.39, "discounted_cash": 54.17, "estimated_discounted_cash": 57.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 41.11, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 46.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL SCOPE W/TUMOR RESECT", "code_information": [{"code": "50562", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RENEW SKIN REPAIR CREAM", "code_information": [{"code": "3001299", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RENIN ACTIVITY & ALDOSTERONE", "code_information": [{"code": "84244", "type": "CPT"}, {"code": "1000249", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 25.29, "maximum": 117.18, "gross_charge": 130.2, "discounted_cash": 54.17, "estimated_discounted_cash": 130.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 117.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN ACTIVITY, PLASMA", "code_information": [{"code": "84244", "type": "CPT"}, {"code": "1000680", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 25.29, "maximum": 117.18, "gross_charge": 130.2, "discounted_cash": 54.17, "estimated_discounted_cash": 130.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 117.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80416", "type": "CPT"}], "standard_charges": [{"minimum": 26.51, "maximum": 240.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 240.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80417", "type": "CPT"}], "standard_charges": [{"minimum": 26.51, "maximum": 50.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RENVELA (SEVELAKER CARBONATE) 800MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001147", "type": "CDM"}, {"code": "50268072015", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.39, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REOP REQ BLD GRFT OTH", "code_information": [{"code": "G8577", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58345", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REOPENING OF ABDOMEN", "code_information": [{"code": "49002", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REOPERATION BYPASS GRAFT", "code_information": [{"code": "35700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REOPERATION CAROTID ADD-ON", "code_information": [{"code": "35390", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP BROKE COMP DENT BASE MAN", "code_information": [{"code": "D5511", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP BROKE COMP DENT BASE MAX", "code_information": [{"code": "D5512", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP CAST PART FRAME MAN", "code_information": [{"code": "D5621", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP CAST PART FRAME MAX", "code_information": [{"code": "D5622", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP DEV, URINARY, W/O SLING", "code_information": [{"code": "C2631", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP DEV, URINARY, W/SLING", "code_information": [{"code": "C1771", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP NPH/URT CATH W/DIL STRIC", "code_information": [{"code": "C7546", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP OF ORTHO APPLIANCE MAN", "code_information": [{"code": "D8697", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP OF ORTHO APPLIANCE MAX", "code_information": [{"code": "D8696", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP PARTIAL DENTURE CLASP", "code_information": [{"code": "D5630", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER FISTU", "code_information": [{"code": "46715", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER/VESTIB FISTU", "code_information": [{"code": "46716", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP RESIN PART DENT BASE MAN", "code_information": [{"code": "D5611", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP RESIN PART DENT BASE MAX", "code_information": [{"code": "D5612", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR & REVISE NERVE ADD-ON", "code_information": [{"code": "64874", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ACHILLES TENDON", "code_information": [{"code": "27650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ANAL FISTULA", "code_information": [{"code": "46288", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ANOMALY W/CONDUIT", "code_information": [{"code": "33608", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ANORECTAL FIST W/PLUG", "code_information": [{"code": "46707", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARM/LEG NERVE", "code_information": [{"code": "64857", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ART INTRAMURAL", "code_information": [{"code": "33507", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERIAL TRUNK", "code_information": [{"code": "33786", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35082", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35092", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35103", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE ARM", "code_information": [{"code": "35013", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE BELLY", "code_information": [{"code": "35122", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE CHEST", "code_information": [{"code": "35022", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE GROIN", "code_information": [{"code": "35132", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE NECK", "code_information": [{"code": "35002", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE SPLEEN", "code_information": [{"code": "35112", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE THIGH", "code_information": [{"code": "35142", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY TRANSLOCATION", "code_information": [{"code": "33506", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY W/TUNNEL", "code_information": [{"code": "33505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BICEPS TENDON", "code_information": [{"code": "23430", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER & VAGINA", "code_information": [{"code": "57289", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER DEFECT", "code_information": [{"code": "57288", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER NECK", "code_information": [{"code": "51845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57330", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER/VAGINA LESION", "code_information": [{"code": "51900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35180", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35182", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35184", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35188", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35189", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35190", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35201", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35206", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35207", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35211", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35216", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35221", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35226", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35231", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35236", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35241", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35246", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35251", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35256", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35261", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35266", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35271", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35276", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35281", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35286", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL FISTULA", "code_information": [{"code": "44650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44625", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44626", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44661", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-SKIN FISTULA", "code_information": [{"code": "44640", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BRAIN FLUID LEAKAGE", "code_information": [{"code": "62100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BRONCHUS ADD-ON", "code_information": [{"code": "32501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BROW DEFECT", "code_information": [{"code": "67900", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BY ENLARGEMENT", "code_information": [{"code": "33610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CARPAL BONE SHORTEN", "code_information": [{"code": "25394", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40700", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40701", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40702", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40720", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40761", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CLITORIS", "code_information": [{"code": "56805", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR COMMUNICATION DEVICE", "code_information": [{"code": "V5336", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CORPOREAL TEAR", "code_information": [{"code": "54437", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARM ARTERY", "code_information": [{"code": "35045", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35011", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35021", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35081", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35091", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35111", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35121", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35131", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35141", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFORMITY OF TOE", "code_information": [{"code": "28313", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEGENERATED KNEECAP", "code_information": [{"code": "27418", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67107", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67108", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67110", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA CRTX", "code_information": [{"code": "67101", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA PC", "code_information": [{"code": "67105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DIAPHRAGM LACERATION", "code_information": [{"code": "39501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATED JAW", "code_information": [{"code": "21490", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33611", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33612", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61618", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61619", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69631", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69635", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW DEB/ATTCH OPEN", "code_information": [{"code": "24359", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW PERC", "code_information": [{"code": "24357", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW W/DEB OPEN", "code_information": [{"code": "24358", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43312", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43410", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43415", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTRA TOE(S)", "code_information": [{"code": "28344", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67901", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67902", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67903", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67904", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67906", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67908", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67914", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67915", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67916", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67917", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67921", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67923", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67924", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67930", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67935", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69740", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69745", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FIBULA NONUNION", "code_information": [{"code": "27726", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER DEFORMITY", "code_information": [{"code": "26590", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26418", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26432", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26433", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26350", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26356", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26357", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26370", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26373", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26426", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45805", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45825", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FIXED RETAINER MAX", "code_information": [{"code": "D8701", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28555", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28585", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28615", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON SHEATH", "code_information": [{"code": "25275", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25260", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25263", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25265", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25272", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25274", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33771", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33774", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33775", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33776", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33777", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33778", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33779", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33780", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33781", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GUM", "code_information": [{"code": "41872", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND DEFORMITY", "code_information": [{"code": "26580", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT", "code_information": [{"code": "26540", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT WITH GRAFT", "code_information": [{"code": "26541", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT WITH GRAFT", "code_information": [{"code": "26542", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND TENDON", "code_information": [{"code": "26410", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33641", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33681", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33684", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33688", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECTS", "code_information": [{"code": "33647", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT", "code_information": [{"code": "33732", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT(S)", "code_information": [{"code": "33730", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HUMERUS WITH GRAFT", "code_information": [{"code": "24435", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR IMPLANT", "code_information": [{"code": "D6090", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ING HERNIA SLIDING", "code_information": [{"code": "49525", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66680", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66682", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LAC PALATE<2 CM", "code_information": [{"code": "42180", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LAMINECTOMY DEFECT", "code_information": [{"code": "63295", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB DUAL", "code_information": [{"code": "33220", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB ONE", "code_information": [{"code": "33218", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LEG FASCIA DEFECT", "code_information": [{"code": "27656", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47360", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47361", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47362", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG EPIPHYSES", "code_information": [{"code": "27734", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27675", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27676", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LUMBAR HERNIA", "code_information": [{"code": "49540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LUNG HERNIA", "code_information": [{"code": "32800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33322", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR VESSEL", "code_information": [{"code": "33321", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAXILLOFACIAL DEFECTS", "code_information": [{"code": "D7955", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAXILLOFACIAL PROSTH", "code_information": [{"code": "L8049", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69666", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69667", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MODIFIED FONTAN", "code_information": [{"code": "33615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH/NOSE FISTULA", "code_information": [{"code": "30600", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MULTI-COMP PENIS PROS", "code_information": [{"code": "54408", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MUSCLES OF HAND", "code_information": [{"code": "26591", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL SEPTUM DEFECT", "code_information": [{"code": "30630", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL STENOSIS", "code_information": [{"code": "30465", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64832", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64837", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE/SHORTEN BONE", "code_information": [{"code": "64876", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION CARPAL BONE", "code_information": [{"code": "25431", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION HAND", "code_information": [{"code": "26546", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR NOSE TO LIP FISTULA", "code_information": [{"code": "42260", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ABDOMINAL WALL", "code_information": [{"code": "49900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ACHILLES TENDON", "code_information": [{"code": "27654", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46750", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46751", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46760", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46761", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46700", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46705", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27695", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27698", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENTS", "code_information": [{"code": "27696", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33414", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33417", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ARM NERVES", "code_information": [{"code": "64861", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER OPENING", "code_information": [{"code": "51880", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51865", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BODY CAST", "code_information": [{"code": "29720", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL BULGE", "code_information": [{"code": "57268", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL LESION", "code_information": [{"code": "44605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL POUCH", "code_information": [{"code": "57270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CIRCUMCISION", "code_information": [{"code": "54163", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46744", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46746", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46748", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39503", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39541", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIGIT NERVE", "code_information": [{"code": "64831", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EARDRUM", "code_information": [{"code": "69610", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EARDRUM", "code_information": [{"code": "69620", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE SOCKET WOUND", "code_information": [{"code": "65290", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65270", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65272", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65273", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65275", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65286", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64864", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64865", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIBULA EPIPHYSIS", "code_information": [{"code": "27732", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIXED RETAINER MAN", "code_information": [{"code": "D8702", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT BONES", "code_information": [{"code": "28320", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28200", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28208", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28285", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28286", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64834", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64835", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64836", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART CHAMBERS", "code_information": [{"code": "33670", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DAMAGE", "code_information": [{"code": "33545", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECT", "code_information": [{"code": "33720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33665", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33692", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33694", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33697", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33702", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33710", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HUMERUS", "code_information": [{"code": "24430", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HYDROCELE", "code_information": [{"code": "55060", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF IMPERFORATED ANUS", "code_information": [{"code": "46742", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KIDNEY WOUND", "code_information": [{"code": "50500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE CARTILAGE", "code_information": [{"code": "27403", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENT", "code_information": [{"code": "27405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENT", "code_information": [{"code": "27407", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENTS", "code_information": [{"code": "27409", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEECAP TENDON", "code_information": [{"code": "27380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27742", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG NERVE", "code_information": [{"code": "64840", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27658", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27659", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27664", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27665", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOW BACK NERVES", "code_information": [{"code": "64862", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27725", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27727", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MESENTERY", "code_information": [{"code": "44850", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF METATARSALS", "code_information": [{"code": "28322", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33426", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33427", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NAIL BED", "code_information": [{"code": "11760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NASAL SEPTUM", "code_information": [{"code": "30520", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PENIS", "code_information": [{"code": "54440", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PERINEUM", "code_information": [{"code": "56810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTOCELE", "code_information": [{"code": "45560", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45500", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45505", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED SPLEEN", "code_information": [{"code": "38115", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED TENDON", "code_information": [{"code": "24342", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED UTERUS", "code_information": [{"code": "58520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SHOULDER", "code_information": [{"code": "23420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SKULL & BRAIN", "code_information": [{"code": "62145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPERM DUCT", "code_information": [{"code": "55400", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63702", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63704", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63706", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STERNUM SEPARATION", "code_information": [{"code": "21750", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STOMACH LESION", "code_information": [{"code": "43840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH", "code_information": [{"code": "27470", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH MUSCLE", "code_information": [{"code": "27385", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA", "code_information": [{"code": "27720", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA EPIPHYSIS", "code_information": [{"code": "27730", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TOE DISLOCATION", "code_information": [{"code": "28675", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER", "code_information": [{"code": "50900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER LESION", "code_information": [{"code": "51535", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53275", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53520", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53502", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53505", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53515", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRAL LESION", "code_information": [{"code": "57230", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF UTERUS", "code_information": [{"code": "59350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "56800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "57200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26560", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26561", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26562", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31750", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31755", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31760", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE DEFECT", "code_information": [{"code": "31825", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31805", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OVIDUCT", "code_information": [{"code": "58750", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42182", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42235", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE PHARYNX/UVULA", "code_information": [{"code": "42145", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT LAP", "code_information": [{"code": "57423", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT OPEN", "code_information": [{"code": "57284", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT VAG", "code_information": [{"code": "57285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54380", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54385", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS AND BLADDER", "code_information": [{"code": "54390", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PROSTH VALVE CLOT", "code_information": [{"code": "33496", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PROSTHESIS PER 15 MIN", "code_information": [{"code": "L7520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PUL VENOUS STENOSIS", "code_information": [{"code": "33726", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ARTERY", "code_information": [{"code": "33917", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ATRESIA", "code_information": [{"code": "33920", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS & ULNA", "code_information": [{"code": "25415", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS OR ULNA", "code_information": [{"code": "25400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECT/BLADDER FISTULA", "code_information": [{"code": "45800", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTOURETHRAL FISTULA", "code_information": [{"code": "45820", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM & VAGINA", "code_information": [{"code": "57250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM/REMOVE SIGMOID", "code_information": [{"code": "45550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RETINAL DETACH CPLX", "code_information": [{"code": "67113", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF ACUTE", "code_information": [{"code": "23410", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF CHRONIC", "code_information": [{"code": "23412", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RUPTD POPLITEAL ART", "code_information": [{"code": "35152", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42500", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42505", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SCIATIC NERVE", "code_information": [{"code": "64858", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33814", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33852", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33853", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23455", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23460", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23462", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23465", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23466", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33617", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33619", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SKULL CAVITY LESION", "code_information": [{"code": "62120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9949", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID LEAKAGE", "code_information": [{"code": "63707", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID LEAKAGE", "code_information": [{"code": "63709", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR STERN/NUSS W/O SCOPE", "code_information": [{"code": "21742", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR STERNUM/NUSS W/SCOPE", "code_information": [{"code": "21743", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH OPENING", "code_information": [{"code": "43870", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH-BOWEL FISTULA", "code_information": [{"code": "43880", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33418", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33419", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TEAR DUCTS", "code_information": [{"code": "68700", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TESTIS INJURY", "code_information": [{"code": "54670", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT ESOPHAGUS", "code_information": [{"code": "42953", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT WOUND", "code_information": [{"code": "42900", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TOE DISLOCATION", "code_information": [{"code": "28645", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41251", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TOOTH SOCKET", "code_information": [{"code": "41874", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36575", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36576", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49611", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UPPER JAW FISTULA", "code_information": [{"code": "30580", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57311", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR URO SPHINCTER", "code_information": [{"code": "53449", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA", "code_information": [{"code": "57335", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA/PERINEUM", "code_information": [{"code": "57210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VALVE FEMORAL VEIN", "code_information": [{"code": "34501", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VENOUS ANOMALY", "code_information": [{"code": "33724", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33802", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33803", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL GRAFT DEFECT", "code_information": [{"code": "35870", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR WEBBED TOE(S)", "code_information": [{"code": "28345", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31613", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31614", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR WRIST JOINTS", "code_information": [{"code": "25447", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT ACHILLES TENDON", "code_information": [{"code": "27652", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT EYE LESION", "code_information": [{"code": "66225", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FEMUR HEAD/NECK", "code_information": [{"code": "27170", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26420", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26428", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26434", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26352", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26358", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26372", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26392", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26412", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT KNEECAP TENDON", "code_information": [{"code": "27381", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF BRONCHUS", "code_information": [{"code": "31770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28202", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28210", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH", "code_information": [{"code": "27472", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH MUSCLE", "code_information": [{"code": "27386", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27722", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27724", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25426", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25425", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT WRIST BONE", "code_information": [{"code": "25440", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/MAINT CONT HEMO EQUIP", "code_information": [{"code": "A4890", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/RELINE OCCLUSAL GUARD", "code_information": [{"code": "D9942", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/REVISE WRIST JOINT", "code_information": [{"code": "25320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/SVC DME NON-OXYGEN EQ", "code_information": [{"code": "K0739", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/SVC OXYGEN EQUIPMENT", "code_information": [{"code": "K0740", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/TRANSPOSE NERVE", "code_information": [{"code": "64856", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPEAT CONTROL OF NOSEBLEED", "code_information": [{"code": "30906", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPEAT THYROID SURGERY", "code_information": [{"code": "60260", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPL SEMI/PRECISION ATTACH", "code_information": [{"code": "D6091", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33362", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33363", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33364", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33365", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE PERQ", "code_information": [{"code": "33361", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33367", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33368", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33369", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE BLOOD LEAK DETECTOR", "code_information": [{"code": "E1560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE BRAIN CAVITY SHUNT", "code_information": [{"code": "62258", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE BROKEN RETAINER MAN", "code_information": [{"code": "D8704", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE BROKEN RETAINER MAX", "code_information": [{"code": "D8703", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE CVAD CATH", "code_information": [{"code": "36580", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE DENTURE TEETH COMPLT", "code_information": [{"code": "D5520", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49451", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE ELBOW JOINT", "code_information": [{"code": "24363", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE EYE FLUID", "code_information": [{"code": "67025", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE G-J TUBE PERC", "code_information": [{"code": "49452", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE G/C TUBE PERC", "code_information": [{"code": "49450", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE MATERIAL PROSTHESIS", "code_information": [{"code": "D6197", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE PART DENTURE TEETH", "code_information": [{"code": "D5640", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE PICVAD CATH", "code_information": [{"code": "36585", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE TRICUSPID VALVE", "code_information": [{"code": "33465", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36578", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36581", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36582", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36583", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE URETER BY BOWEL", "code_information": [{"code": "50840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/BP", "code_information": [{"code": "33983", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/O BP", "code_information": [{"code": "33982", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD PUMP EXT", "code_information": [{"code": "33981", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62194", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62225", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE/REVISE BRAIN SHUNT", "code_information": [{"code": "62230", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AIR BUBBLE DETEC", "code_information": [{"code": "E1530", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33406", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33410", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT BLOOD PUMP", "code_information": [{"code": "E1620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT BREASTPUMP ADPT", "code_information": [{"code": "A4282", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT BREASTPUMP CAP", "code_information": [{"code": "A4283", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT BREASTPUMP TUBE", "code_information": [{"code": "A4281", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT BULB TH LIGHTBOX", "code_information": [{"code": "A4634", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT NASAL PROSTHESIS", "code_information": [{"code": "D5926", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33411", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33412", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33413", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF CONTACT LENS", "code_information": [{"code": "92326", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF MITRAL VALVE", "code_information": [{"code": "33430", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF PRECISION ATT", "code_information": [{"code": "D5867", "type": "HCPCS"}], "standard_charges": [{"minimum": 666.39, "maximum": 666.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT PRESSURE ALARM", "code_information": [{"code": "E1540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT PULMONARY VALVE", "code_information": [{"code": "33475", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANT FOREARM COMPLETE", "code_information": [{"code": "20805", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION ARM COMPLETE", "code_information": [{"code": "20802", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20816", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20822", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION FOOT COMPLETE", "code_information": [{"code": "20838", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION HAND COMPLETE", "code_information": [{"code": "20808", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20824", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20827", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLC TTH&ACRLC MANDIBULAR", "code_information": [{"code": "D5671", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLC TTH&ACRLC ON MTL FRMWK", "code_information": [{"code": "D5670", "type": "HCPCS"}], "standard_charges": [{"minimum": 823.93, "maximum": 823.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 823.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLCMNT BREAST PUMP BOTTLE", "code_information": [{"code": "A4285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLCMNT BREAST PUMP SHIELD", "code_information": [{"code": "A4284", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLCMNT BREASTPUMP LOK RING", "code_information": [{"code": "A4286", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOS CAR MODULJ TRANVNS ELT", "code_information": [{"code": "415T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOS PREV IMPLTBL SUBQ DFB", "code_information": [{"code": "33273", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOS PREV SS IMPL DFB ELTRD", "code_information": [{"code": "574T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSG PERQ R/L HRT VAD", "code_information": [{"code": "33993", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSG PHRNC NRV STIM TRNSVN", "code_information": [{"code": "33281", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSITION GASTROSTOMY TUBE", "code_information": [{"code": "43761", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSITION INTRAOCULAR LENS", "code_information": [{"code": "66825", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSITION L VENTRIC LEAD", "code_information": [{"code": "33226", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSITION PACING-DEFIB LEAD", "code_information": [{"code": "33215", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSITION VENOUS CATHETER", "code_information": [{"code": "36597", "type": "CPT"}], "standard_charges": [{"minimum": 7010.67, "maximum": 7010.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7010.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSITIONING OF TEETH", "code_information": [{"code": "D7290", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX EYE,NOSE LIPS 1.0CM-LESS TECH", "code_information": [{"code": "13150", "type": "CPT"}, {"code": "11000110", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 1180.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REPR CMPLX EYE,NOSE, 2.6CM-7.5 (TECH)", "code_information": [{"code": "13152", "type": "CPT"}, {"code": "11000308", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 890.77, "maximum": 1406.48, "gross_charge": 1562.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1172.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1250.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1406.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 890.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX EYE,NOSE, L 2.5CM-LESS (TECH)", "code_information": [{"code": "13151", "type": "CPT"}, {"code": "11000120", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX EYE,NOSE,LI EACH ADD 5CM TECH", "code_information": [{"code": "13153", "type": "CPT"}, {"code": "11000133", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 430.03, "maximum": 678.99, "gross_charge": 754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 565.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 603.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 678.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 430.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX FCE, HNDS 2.5CM-LESS (TECH)", "code_information": [{"code": "13131", "type": "CPT"}, {"code": "11000119", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX FCE, HNDS 2.6CM-7.5 (TECH)", "code_information": [{"code": "13132", "type": "CPT"}, {"code": "11000125", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX FCE, HNDS EACH ADD 5CM", "code_information": [{"code": "13133", "type": "CPT"}, {"code": "11000127", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 430.03, "maximum": 678.99, "gross_charge": 754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 565.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 603.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 678.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 430.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX SCLP,ARM 2.6CM-7.5 (TECH)", "code_information": [{"code": "13121", "type": "CPT"}, {"code": "11000124", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX SCLP,ARM EACH ADD 5CM TECH", "code_information": [{"code": "13122", "type": "CPT"}, {"code": "11000132", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 146.63, "maximum": 231.52, "gross_charge": 257.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 192.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 231.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 146.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR CMPLX SCLP,ARM, 2.5CM-LESS (TECH)", "code_information": [{"code": "13120", "type": "CPT"}, {"code": "11000115", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR COMPLEX WND 1.1-2.5CM TECH", "code_information": [{"code": "13100", "type": "CPT"}, {"code": "11000113", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR COMPLEX WND 2.5CM-LESS(TECH)", "code_information": [{"code": "13151", "type": "CPT"}, {"code": "11000121", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR COMPLEX WND 2.6-7.5CM TECH", "code_information": [{"code": "13101", "type": "CPT"}, {"code": "11000123", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR COMPLEX WND EACH ADD 5CM (TECH)", "code_information": [{"code": "13102", "type": "CPT"}, {"code": "11000128", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 430.03, "maximum": 678.99, "gross_charge": 754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 565.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 603.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 678.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 430.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR DEHISCED SUPERF WND SIMPLE TECH", "code_information": [{"code": "12020", "type": "CPT"}, {"code": "11000134", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR DEHISCED SUPERF WND/PACKING TECH", "code_information": [{"code": "12021", "type": "CPT"}, {"code": "11000136", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR ELBOW LAT LIGMNT W/TISS", "code_information": [{"code": "24343", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR ELBW MED LIGMNT W/TISSU", "code_information": [{"code": "24345", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 12.6-20.0 (TECH)", "code_information": [{"code": "12045", "type": "CPT"}, {"code": "11000139", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 12.6CM-20.0 (TECH)", "code_information": [{"code": "12055", "type": "CPT"}, {"code": "11000140", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 12.6CM-20.0CM (TECH)", "code_information": [{"code": "12035", "type": "CPT"}, {"code": "11000144", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "estimated_discounted_cash": 932.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 2.5CM-LESS (TECH)", "code_information": [{"code": "12041", "type": "CPT"}, {"code": "11000146", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 2.5CM-LESS (TECH)", "code_information": [{"code": "12051", "type": "CPT"}, {"code": "11000147", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 2.5CM-LESS TECH", "code_information": [{"code": "12031", "type": "CPT"}, {"code": "11000148", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 2.6CM-5.0 (TECH)", "code_information": [{"code": "12052", "type": "CPT"}, {"code": "11000151", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "estimated_discounted_cash": 932.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 2.6CM-7.5 (TECH)", "code_information": [{"code": "12032", "type": "CPT"}, {"code": "11000152", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "estimated_discounted_cash": 932.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 2.6CM-7.5CM TECH", "code_information": [{"code": "12042", "type": "CPT"}, {"code": "11000153", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 20.1-30.0CM (TECH)", "code_information": [{"code": "12036", "type": "CPT"}, {"code": "11000156", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 20.1CM-30.0 (TECH)", "code_information": [{"code": "12046", "type": "CPT"}, {"code": "11000157", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 20.1CM-30.0 (TECH)", "code_information": [{"code": "12056", "type": "CPT"}, {"code": "11000158", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 5.1CM-7.5CM (TECH)", "code_information": [{"code": "12053", "type": "CPT"}, {"code": "11000161", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 7.6CM-12.5 (TECH)", "code_information": [{"code": "12034", "type": "CPT"}, {"code": "11000163", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 7.6CM-12.5 (TECH)", "code_information": [{"code": "12044", "type": "CPT"}, {"code": "11000164", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 834.82, "maximum": 1318.14, "gross_charge": 1464.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1098.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1171.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1318.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND 7.6CM-12.5 (TECH)", "code_information": [{"code": "12054", "type": "CPT"}, {"code": "11000165", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND OVER 30.0CM (TECH)", "code_information": [{"code": "12047", "type": "CPT"}, {"code": "11000170", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 2682.01, "maximum": 4234.76, "gross_charge": 4705.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3528.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3764.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 4234.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2682.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND OVER 30.0CM (TECH)", "code_information": [{"code": "12057", "type": "CPT"}, {"code": "11000171", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR INTRMD WND OVER 30.0CM TECH", "code_information": [{"code": "12037", "type": "CPT"}, {"code": "11000173", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 2682.01, "maximum": 4234.76, "gross_charge": 4705.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3528.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3764.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 4234.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2682.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR LAC TONGUE 2.5-LESS TECH", "code_information": [{"code": "41250", "type": "CPT"}, {"code": "11000175", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 2932.02, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR LAC TONGUE 2.6-OVER TECH", "code_information": [{"code": "41252", "type": "CPT"}, {"code": "11000177", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 852.55, "maximum": 2932.02, "gross_charge": 1495.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1121.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1196.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1346.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 852.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR MOUTH LAC TECH", "code_information": [{"code": "40831", "type": "CPT"}, {"code": "11000179", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 786.37, "maximum": 2932.02, "gross_charge": 1379.61, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1034.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1103.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1241.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 786.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR MOUTH LACERATION TECH", "code_information": [{"code": "40830", "type": "CPT"}, {"code": "11000181", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 392.97, "maximum": 620.48, "gross_charge": 689.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 517.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 551.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 620.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 392.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR OF ANAL FISTULA W/GLUE", "code_information": [{"code": "46706", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH DBL PROC", "code_information": [{"code": "46712", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH SNGL PROC", "code_information": [{"code": "46710", "type": "CPT"}], "standard_charges": [{"minimum": 7170.88, "maximum": 7170.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7170.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR PUL ART UNIFOCAL W/CPB", "code_information": [{"code": "33926", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND 12.6CM-20.0CM SIMPLE TEC", "code_information": [{"code": "12016", "type": "CPT"}, {"code": "11000185", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND 2.6-5.0CM SIMPLE (TECH)", "code_information": [{"code": "12013", "type": "CPT"}, {"code": "11000192", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "estimated_discounted_cash": 506.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND 2.6CM-7.5 SIMPLE TECH", "code_information": [{"code": "12002", "type": "CPT"}, {"code": "11000193", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "estimated_discounted_cash": 506.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND 20.1-30.0 SIMPLE TECH", "code_information": [{"code": "12006", "type": "CPT"}, {"code": "11000195", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND 5.1CM-7.5CM SIMPLE TECH", "code_information": [{"code": "12014", "type": "CPT"}, {"code": "11000198", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND 7.6CM-12.5 SIMPLE (TECH)", "code_information": [{"code": "12015", "type": "CPT"}, {"code": "11000200", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND 7.6CM-12.5 SIMPLE TECH", "code_information": [{"code": "12004", "type": "CPT"}, {"code": "11000202", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "estimated_discounted_cash": 506.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND OVER 30.0 SIMPLE TECH", "code_information": [{"code": "12018", "type": "CPT"}, {"code": "11000204", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 430.03, "maximum": 678.99, "gross_charge": 754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 565.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 603.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 678.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 430.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPERF WND OVER 30.0CM SIMPLE TECH", "code_information": [{"code": "12007", "type": "CPT"}, {"code": "11000205", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPRERF WND 20.1-30.0CM SIMPLE TECH", "code_information": [{"code": "12017", "type": "CPT"}, {"code": "11000206", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPRF WND 12.6CM-20.0 SIMPLE TECH", "code_information": [{"code": "12005", "type": "CPT"}, {"code": "11000207", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 531.46, "maximum": 839.16, "gross_charge": 932.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 745.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 531.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPRWND 2.5CM-LSS SIM FACE (TECH)", "code_information": [{"code": "12011", "type": "CPT"}, {"code": "11000188", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "estimated_discounted_cash": 506.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR SUPRWND 2.5CM-LSS SIM TRUNK TECH", "code_information": [{"code": "12001", "type": "CPT"}, {"code": "11000190", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "estimated_discounted_cash": 506.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRDTVE MED ALYS 24 CHRMSM", "code_information": [{"code": "254U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPRGRMG IO RTA ELTRD RA", "code_information": [{"code": "473T", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPRIZA, 1CM", "code_information": [{"code": "Q4143", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT 7/>", "code_information": [{"code": "92604", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT <7", "code_information": [{"code": "92602", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPTILASE TEST", "code_information": [{"code": "85635", "type": "CPT"}], "standard_charges": [{"minimum": 11.33, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REQ RET OR W/IN 90D OF SURG", "code_information": [{"code": "G9514", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REQUIP (ROPINIROLE HCL) 4MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003909", "type": "CDM"}, {"code": "43547027310", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REQUIP (ROPINIROLE HCL) TAB 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000516", "type": "CDM"}, {"code": "43547026910", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REQUIP (ROPINIROLE HCL) TAB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000996", "type": "CDM"}, {"code": "43547027110", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REQUIP (ROPINIROLE HCL) TABLET 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001032", "type": "CDM"}, {"code": "43547026810", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REQUIP (ROPONIROLE) 1MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001810", "type": "CDM"}, {"code": "43547027010", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REREMOVE WRIST TENDON LESION", "code_information": [{"code": "25112", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA BLOCKED", "code_information": [{"code": "49557", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA REDUCE", "code_information": [{"code": "49555", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA BLOCKED", "code_information": [{"code": "49521", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA REDUCE", "code_information": [{"code": "49520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REREVISE EYE MUSCLES ADD-ON", "code_information": [{"code": "67332", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RES CARE, NOS WAIVER/MONTH", "code_information": [{"code": "T2032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RES CHANGE SC < 0", "code_information": [{"code": "G2167", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RES CHANGE SC >=0", "code_information": [{"code": "G2152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RES, NOS WAIVER PER DIEM", "code_information": [{"code": "T2033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUM/CHEST", "code_information": [{"code": "32504", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUMOR", "code_information": [{"code": "32503", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM 5 CM/>", "code_information": [{"code": "21936", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM < 5 CM", "code_information": [{"code": "21935", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT CLAVICLE TUMOR", "code_information": [{"code": "23200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM COMPLEX", "code_information": [{"code": "39561", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM SIMPLE", "code_information": [{"code": "39560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT DISTAL FINGER TUMOR", "code_information": [{"code": "26262", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE", "code_information": [{"code": "28341", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE TISSUE", "code_information": [{"code": "28340", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM 2 CM/>", "code_information": [{"code": "21016", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM < 2 CM", "code_information": [{"code": "21015", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FEMUR/KNEE TUMOR", "code_information": [{"code": "27365", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FIBULA TUMOR", "code_information": [{"code": "27646", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR 3 CM/>", "code_information": [{"code": "28047", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR < 3 CM", "code_information": [{"code": "28046", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FORARM/WRIST TUM 3CM>", "code_information": [{"code": "25078", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FOREARM/WRIST TUM<3CM", "code_information": [{"code": "25077", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HEART SAC LESION", "code_information": [{"code": "33050", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM INCL ACETABUL", "code_information": [{"code": "27076", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM W/INNOM BONE", "code_information": [{"code": "27077", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUMOR", "code_information": [{"code": "27075", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM 5 CM/>", "code_information": [{"code": "27059", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM < 5 CM", "code_information": [{"code": "27049", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT INFERIOR TURBINATE", "code_information": [{"code": "30140", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM 5 CM/>", "code_information": [{"code": "27616", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM < 5 CM", "code_information": [{"code": "27615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL CYST", "code_information": [{"code": "39200", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL TUMOR", "code_information": [{"code": "39220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT METATARSAL TUMOR", "code_information": [{"code": "28173", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT NASOPHARYNX SKULL", "code_information": [{"code": "61586", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT NECK THORAX TUMOR<5CM", "code_information": [{"code": "21557", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT NECK TUMOR 5 CM/>", "code_information": [{"code": "21558", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58950", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58951", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58952", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT PHALANX OF TOE TUMOR", "code_information": [{"code": "28175", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT PROX FINGER TUMOR", "code_information": [{"code": "26260", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT PROX HUMERUS TUMOR", "code_information": [{"code": "23220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT RADIUS/ULNAR TUMOR", "code_information": [{"code": "25170", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT RECUR GYN MAL W/LYM", "code_information": [{"code": "58958", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT SCAPULA TUMOR", "code_information": [{"code": "23210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR 5 CM/>", "code_information": [{"code": "23078", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR < 5 CM", "code_information": [{"code": "23077", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT TALUS/CALCANEUS TUM", "code_information": [{"code": "27647", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT TARSAL TUMOR", "code_information": [{"code": "28171", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM 5 CM/>", "code_information": [{"code": "27364", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM < 5 CM", "code_information": [{"code": "27329", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT TIBIA TUMOR", "code_information": [{"code": "27645", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/DEBRIDE PANCREAS", "code_information": [{"code": "48105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61601", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61607", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61608", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61616", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECTION OF ELBOW JOINT", "code_information": [{"code": "24155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21480", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21485", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESHAPING BONE ORTHOGNATHIC", "code_information": [{"code": "D7940", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESIN 4/> SURF OR W INCIS AN", "code_information": [{"code": "D2335", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESIN INFILTRATION OF LESION", "code_information": [{"code": "D2990", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESIN ONE SURFACE-ANTERIOR", "code_information": [{"code": "D2330", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESIN RETAINER", "code_information": [{"code": "D6549", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESIN THREE SURFACES-ANTERIO", "code_information": [{"code": "D2332", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESIN TWO SURFACES-ANTERIOR", "code_information": [{"code": "D2331", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESOLVE MATRIX PER SQ CM", "code_information": [{"code": "A2024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESOURCE-INTEN SVC DURING OV", "code_information": [{"code": "G0501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 3-5 TARGETS", "code_information": [{"code": "87631", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 164.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 164.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 6-11 TARGETS", "code_information": [{"code": "87632", "type": "CPT"}], "standard_charges": [{"minimum": 87.73, "maximum": 250.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 250.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESPIR IADNA 18 VIRAL&2 BACT", "code_information": [{"code": "115U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESPIRATOR MOTION MGMT SIMUL", "code_information": [{"code": "77293", "type": "CPT"}], "standard_charges": [{"minimum": 675.18, "maximum": 675.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 675.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY FLOW VOLUME LOOP", "code_information": [{"code": "94375", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [{"code": "178", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 5511.08, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [{"code": "177", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 4398.23, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC", "code_information": [{"code": "179", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [{"code": "181", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [{"code": "180", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "182", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY PATHOGEN PANEL", "code_information": [{"code": "87633", "type": "CPT"}, {"code": "1099032", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 87.73, "maximum": 756.0, "gross_charge": 840.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 479.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 478.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [{"code": "204", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYNCYTIAL AG IF", "code_information": [{"code": "87280", "type": "CPT"}], "standard_charges": [{"minimum": 15.43, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [{"code": "208", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [{"code": "207", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY VIRUS ANTIBODY", "code_information": [{"code": "86756", "type": "CPT"}], "standard_charges": [{"minimum": 18.27, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESPITE CARE SERVICE 15 MIN", "code_information": [{"code": "T1005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESPITE CARE, IN THE HOME, P", "code_information": [{"code": "S9125", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESPITE NOT-IN-HOME PER DIEM", "code_information": [{"code": "H0045", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESTASIS 0.05% EYE DROPS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000742", "type": "CDM"}, {"code": "60505620201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 31.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RESTORATIVE FOUNDATION", "code_information": [{"code": "D2949", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESTORE EXTRA THIN HYDROCOLLOID 4X4", "code_information": [{"code": "3001358", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RESTORE/REMODEL VENTRICLE", "code_information": [{"code": "33548", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESTORIGIN 1 SQ CM", "code_information": [{"code": "Q4191", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESTORIGIN, 1 CC", "code_information": [{"code": "Q4192", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESTORIL (TEMAZEPAM) CAP 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000253", "type": "CDM"}, {"code": "00228207610", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RESTRAINT WAIST", "code_information": [{"code": "3000273", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RESTRAINT/LIMB HOLDE", "code_information": [{"code": "3000275", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RESTRAINTS ANY TYPE", "code_information": [{"code": "E0710", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESTRATA, PER SQ CM", "code_information": [{"code": "A2007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESUSCITATION BAG", "code_information": [{"code": "S8999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RET DEV, INSERTABLE", "code_information": [{"code": "C1773", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RET DEV, LASER, IVC FILTER", "code_information": [{"code": "C1603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETACRIT INJ SOLN 4000U/1ML", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "Q5106", "type": "HCPCS"}, {"code": "73004308", "type": "CDM"}, {"code": "00069130710", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 62.72, "maximum": 99.03, "gross_charge": 110.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 82.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 88.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 99.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETAIN CROWN PORC TO TITANIU", "code_information": [{"code": "D6753", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETAIN CROWN RESIN W HI NBLE", "code_information": [{"code": "D6720", "type": "HCPCS"}], "standard_charges": [{"minimum": 1521.6, "maximum": 1521.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1521.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETAIN METAL FPD BASE ALLOYS", "code_information": [{"code": "D6121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETAIN METAL FPD NOBLE ALLOY", "code_information": [{"code": "D6122", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETAIN METAL FPD TITANIUM", "code_information": [{"code": "D6123", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETAINER CROWN 3/4 TITANIUM", "code_information": [{"code": "D6784", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETEPLASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2993", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETICULATED PLATELET ASSAY", "code_information": [{"code": "85055", "type": "CPT"}], "standard_charges": [{"minimum": 41.1, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETICULOCYTE COUNT", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "1000089", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 4.59, "maximum": 22.92, "gross_charge": 25.47, "discounted_cash": 54.17, "estimated_discounted_cash": 25.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [{"code": "815", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [{"code": "814", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "816", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "RETICYTE/HGB CONCENTRATE", "code_information": [{"code": "85046", "type": "CPT"}], "standard_charges": [{"minimum": 6.41, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETINAL TAMP, SILICONE OIL", "code_information": [{"code": "C1814", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETR BONE FLAP TO FIX SKULL", "code_information": [{"code": "62148", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL ANTERIOR", "code_information": [{"code": "D3346", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL MOLAR", "code_information": [{"code": "D3348", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL PREMOLAR", "code_information": [{"code": "D3347", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETRIEVAL OF OOCYTE", "code_information": [{"code": "58970", "type": "CPT"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETROGRADE EJACULATION ANAL", "code_information": [{"code": "89331", "type": "CPT"}], "standard_charges": [{"minimum": 22.53, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETROGRADE FILLING", "code_information": [{"code": "D3430", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE ENEMA BAG", "code_information": [{"code": "A4458", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE ORAL THERMOMETER", "code_information": [{"code": "A4931", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE PULL-ON ANY SIZE", "code_information": [{"code": "T4536", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE RECTAL THERMOMETER", "code_information": [{"code": "A4932", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE UNDERPAD BED SIZE", "code_information": [{"code": "T4537", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE UNDERPAD CHAIR SIZE", "code_information": [{"code": "T4540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSE DIAPER/BRIEF ANY SIZE", "code_information": [{"code": "T4539", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV ARTIFIC DISC ADDL", "code_information": [{"code": "98T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV RPLC/RMV THRC VRT TETHRG", "code_information": [{"code": "22838", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV RPLCM ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22861", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV RPLCM RTHRP 1NTRSPC LMBR", "code_information": [{"code": "22862", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV GEN", "code_information": [{"code": "271T", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV LEAD", "code_information": [{"code": "270T", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV TOTAL", "code_information": [{"code": "269T", "type": "CPT"}], "standard_charges": [{"minimum": 18933.46, "maximum": 18933.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18933.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/RMV IMP SP NPG/R DTCH CN", "code_information": [{"code": "63688", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/RMV PERPH NSTIM ELTRD RA", "code_information": [{"code": "64585", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/RMV PRPH SAC/GSTR NPG/R", "code_information": [{"code": "64595", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/RPLCMT SK-MNT CRNL NSTM", "code_information": [{"code": "61891", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/RPLCT HPGLSL NSTM ARY PG", "code_information": [{"code": "64583", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-ATHER", "code_information": [{"code": "C9766", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-STENT", "code_information": [{"code": "C9765", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIPSY", "code_information": [{"code": "C9764", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITH-STEN-ATH TIB/PER", "code_information": [{"code": "C9775", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-ATHER TIB/PER", "code_information": [{"code": "C9774", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-STENT TIB/PER", "code_information": [{"code": "C9773", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP TIBI/PERONE", "code_information": [{"code": "C9772", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP-STENT-ATHER", "code_information": [{"code": "C9767", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVASCULARIZATION PENIS", "code_information": [{"code": "37788", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVATIO (SILDENAFIL) 20MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002742", "type": "CDM"}, {"code": "00904667106", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "REVEFENACIN INH NON-COM 1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7677", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVERSE OSMOSIS H2O PURI SYS", "code_information": [{"code": "E1610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVERSE T3", "code_information": [{"code": "84482", "type": "CPT"}, {"code": "1000546", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.12, "maximum": 83.97, "gross_charge": 93.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 74.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 83.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 53.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIEW PATIENT SPIROMETRY", "code_information": [{"code": "94016", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23473", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23474", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32905", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32906", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE ABDOMEN-VENOUS SHUNT", "code_information": [{"code": "49426", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE ADDITIONAL LEG TENDON", "code_information": [{"code": "27692", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE AQUEOUS SHUNT EYE", "code_information": [{"code": "66185", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE ARM/LEG NERVE", "code_information": [{"code": "64708", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE BLADDER & URETER(S)", "code_information": [{"code": "51565", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61708", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61710", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE CORNEA WITH IMPLANT", "code_information": [{"code": "65770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE ESOPHAGUS & STOMACH", "code_information": [{"code": "43325", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EXTERNAL EAR", "code_information": [{"code": "69300", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE", "code_information": [{"code": "65091", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67311", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67314", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE ADD-ON", "code_information": [{"code": "67340", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE W/SUTURE", "code_information": [{"code": "67334", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S)", "code_information": [{"code": "67318", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S) ADD-ON", "code_information": [{"code": "67320", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKET IMPLANT", "code_information": [{"code": "67560", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21260", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21261", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21263", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21267", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21268", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE WITH IMPLANT", "code_information": [{"code": "65093", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67825", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67835", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67909", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67911", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68330", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68360", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68362", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT", "code_information": [{"code": "26535", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26135", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26140", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER/TOE NERVE", "code_information": [{"code": "64702", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE GASTRIC PORT OPEN", "code_information": [{"code": "43886", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35879", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35881", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FINGER TENDON", "code_information": [{"code": "26390", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FOOT NERVE", "code_information": [{"code": "64704", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HEAD/NECK OF FEMUR", "code_information": [{"code": "27179", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HERNIA & SPERM VEINS", "code_information": [{"code": "55540", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27134", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27137", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27138", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP", "code_information": [{"code": "27437", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP WITH IMPLANT", "code_information": [{"code": "27438", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE JOINT", "code_information": [{"code": "26530", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE WITH IMPLANT", "code_information": [{"code": "26531", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE LEG VEIN", "code_information": [{"code": "37700", "type": "CPT"}], "standard_charges": [{"minimum": 11693.73, "maximum": 11693.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11693.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE LOW BACK NERVE(S)", "code_information": [{"code": "64714", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27690", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27691", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDONS", "code_information": [{"code": "27686", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE LUMB ARTIF DISC ADDL", "code_information": [{"code": "165T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33822", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33824", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69641", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69642", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69643", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69644", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69645", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69646", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69660", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69661", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69662", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65125", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65150", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE OVARIAN TUBE(S)", "code_information": [{"code": "58752", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25315", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25316", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54328", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54332", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54336", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE PROSTH VAG GRAFT LAP", "code_information": [{"code": "57426", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25365", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25375", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS OR ULNA", "code_information": [{"code": "25370", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24370", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24371", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55530", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55535", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS CRVL", "code_information": [{"code": "63250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS THRC", "code_information": [{"code": "63251", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE CORD VSL THRLMB", "code_information": [{"code": "63252", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE ELTRD PERQ ARAY", "code_information": [{"code": "63663", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE ELTRD PLATE", "code_information": [{"code": "63664", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43865", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE TEAR DUCT OPENING", "code_information": [{"code": "68705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE THIGH MUSCLES/TENDONS", "code_information": [{"code": "27400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26490", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26496", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67312", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67316", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE ULNAR NERVE AT ELBOW", "code_information": [{"code": "64718", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE ULNAR NERVE AT WRIST", "code_information": [{"code": "64719", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50727", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50728", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 1", "code_information": [{"code": "53400", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 2", "code_information": [{"code": "53405", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE URINE FLOW", "code_information": [{"code": "50830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT OPEN ABD", "code_information": [{"code": "57296", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT VIA VAGINA", "code_information": [{"code": "57295", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE VENTRICLE MUSCLE", "code_information": [{"code": "33416", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE WINDPIPE SCAR", "code_information": [{"code": "31830", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST JOINT", "code_information": [{"code": "25332", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST/FOREARM TENDON", "code_information": [{"code": "25280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68320", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68325", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68326", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68328", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68335", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/IMPLANT FINGER JOINT", "code_information": [{"code": "26536", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE ELECTRD ANTRUM", "code_information": [{"code": "43882", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROELECTRODE", "code_information": [{"code": "61880", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEURORECEIVER", "code_information": [{"code": "61888", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE SLING REPAIR", "code_information": [{"code": "57287", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REPL VAGUS N ELTRD", "code_information": [{"code": "64569", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REPLACE KNEE JOINT", "code_information": [{"code": "27486", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REPLACE KNEE JOINT", "code_information": [{"code": "27487", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION GASTROPLASTY", "code_information": [{"code": "43848", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF AMPUTATION", "code_information": [{"code": "24935", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF ANKLE JOINT", "code_information": [{"code": "27700", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF AORTIC VALVE", "code_information": [{"code": "92986", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF AQUEOUS SHUNT", "code_information": [{"code": "66184", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF ARM NERVE(S)", "code_information": [{"code": "64713", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF BIG TOE", "code_information": [{"code": "28310", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER & BOWEL", "code_information": [{"code": "51960", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER NECK", "code_information": [{"code": "52500", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER/URETHRA", "code_information": [{"code": "51800", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CALF TENDON", "code_information": [{"code": "27687", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59325", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37180", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23480", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23485", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44345", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44346", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65600", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65760", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65765", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CRANIAL NERVE", "code_information": [{"code": "64716", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF DIAPHRAGM", "code_information": [{"code": "39545", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF ELBOW JOINT", "code_information": [{"code": "24470", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21280", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21282", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67880", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67882", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67950", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67961", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67966", "type": "CPT"}], "standard_charges": [{"minimum": 8905.33, "maximum": 8905.33, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8905.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FEMUR EPIPHYSIS", "code_information": [{"code": "27185", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FINGER", "code_information": [{"code": "26499", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT", "code_information": [{"code": "28116", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT AND ANKLE", "code_information": [{"code": "28262", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT BONES", "code_information": [{"code": "28737", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT FASCIA", "code_information": [{"code": "28250", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28238", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28261", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33476", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33478", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33735", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33736", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART VEINS", "code_information": [{"code": "33645", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONE", "code_information": [{"code": "27147", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONES", "code_information": [{"code": "27156", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [{"code": "467", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [{"code": "466", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "468", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP TENDON", "code_information": [{"code": "27097", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HORSESHOE KIDNEY", "code_information": [{"code": "50540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24410", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44312", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44314", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF INFUSION PUMP", "code_information": [{"code": "36261", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66761", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66762", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21295", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21296", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27440", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27441", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27442", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27443", "type": "CPT"}], "standard_charges": [{"minimum": 11083.41, "maximum": 11083.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11083.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27445", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27446", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF LARYNX", "code_information": [{"code": "31400", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF LEG VEIN", "code_information": [{"code": "37780", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EYELID", "code_information": [{"code": "15820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EYELID", "code_information": [{"code": "15821", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG", "code_information": [{"code": "27715", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG TENDON", "code_information": [{"code": "27685", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF LUNG", "code_information": [{"code": "32940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37650", "type": "CPT"}], "standard_charges": [{"minimum": 6928.47, "maximum": 6928.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33422", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "92987", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21720", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21725", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE/RIB", "code_information": [{"code": "21705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30120", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30430", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30435", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30450", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30460", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30462", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PELVIS", "code_information": [{"code": "27158", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54300", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54304", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54420", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54430", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54435", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42892", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42894", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY ARTERY", "code_information": [{"code": "33788", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "33474", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "92990", "type": "CPT"}], "standard_charges": [{"minimum": 27447.43, "maximum": 27447.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 27447.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25355", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCIATIC NERVE", "code_information": [{"code": "64712", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55175", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55180", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF SPINAL SHUNT", "code_information": [{"code": "63744", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF TESTIS", "code_information": [{"code": "54660", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF THIGH MUSCLES", "code_information": [{"code": "27430", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF TOE", "code_information": [{"code": "28312", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33460", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33468", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF ULNA", "code_information": [{"code": "25360", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF UNSTABLE KNEECAP", "code_information": [{"code": "27420", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF UNSTABLE KNEECAP", "code_information": [{"code": "27422", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER ARM", "code_information": [{"code": "24940", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EYELID", "code_information": [{"code": "15822", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EYELID", "code_information": [{"code": "15823", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETER", "code_information": [{"code": "50700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53450", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53460", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "57220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF URINARY TRACT", "code_information": [{"code": "51820", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF UTERUS", "code_information": [{"code": "58540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25455", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION ORBITOFACIAL BONES", "code_information": [{"code": "21275", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION SUBVALVULAR TISSUE", "code_information": [{"code": "33415", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION TIPS", "code_information": [{"code": "37183", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL ISDNS PTN", "code_information": [{"code": "588T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL OF KNEECAP", "code_information": [{"code": "27424", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVITA, PER SQ CM", "code_information": [{"code": "Q4180", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVITALON 1 SQUARE CM", "code_information": [{"code": "Q4157", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST AUTOG VN GRF", "code_information": [{"code": "35884", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST NONAUTOG GRF", "code_information": [{"code": "35883", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ PERI-IMPLT CAPSULE BRST", "code_information": [{"code": "19370", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ PRIOR HYPSPAD REPAIR", "code_information": [{"code": "54352", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ RECONSTRUCTED BREAST", "code_information": [{"code": "19380", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ RPLCMT/RMVL VRT TETHRG", "code_information": [{"code": "790T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBF", "code_information": [{"code": "819T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBQ", "code_information": [{"code": "818T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA PN W/INT NSTIM", "code_information": [{"code": "64598", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SAC W/NSTIM", "code_information": [{"code": "787T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SPI W/NSTIM", "code_information": [{"code": "785T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVOSHIELD+ AMNIO, PER SQ CM", "code_information": [{"code": "Q4289", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVSC OPN/PRQ TIB/PERO STENT", "code_information": [{"code": "37234", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REXULTI (BREXPIPRAZOLE) 0.5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004335", "type": "CDM"}, {"code": "59148003613", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 147.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RF ABLTJ NRV NRVTG SI JT", "code_information": [{"code": "64625", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RF SPECTRSC NTRAOP MRGN ASMT", "code_information": [{"code": "546T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RFC1 REPEAT XPNSJ VRNT ALYS", "code_information": [{"code": "378U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RH IG FULL-DOSE IM", "code_information": [{"code": "90384", "type": "CPT"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RH IG IV", "code_information": [{"code": "90386", "type": "CPT"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RH IG MINIDOSE IM", "code_information": [{"code": "90385", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP NEXT GNRJ SEQ", "code_information": [{"code": "222U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP RHD1-10&RHCE5", "code_information": [{"code": "198U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHEUMATIOD FACTOR/RA", "code_information": [{"code": "86431", "type": "CPT"}, {"code": "1000200", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.52, "maximum": 33.38, "gross_charge": 33.6, "discounted_cash": 54.17, "estimated_discounted_cash": 33.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 26.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 30.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 19.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR TEST QUAL", "code_information": [{"code": "86430", "type": "CPT"}], "standard_charges": [{"minimum": 7.06, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHEUMATOLOGY SS", "code_information": [{"code": "G4032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHO D IMMUNE GLOBULIN 50 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2788", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHO D IMMUNE GLOBULIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2790", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHO(D) IMMUNE GLOBULIN H, SD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2792", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHOPHYLAC INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2791", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG REPORT", "code_information": [{"code": "93042", "type": "CPT"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG WITH REPORT", "code_information": [{"code": "93040", "type": "CPT"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RIB CARTILAGE GRAFT", "code_information": [{"code": "21230", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RIBOFLAVIN 5'PHOS OPTH<=3ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2787", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RIFAMPIN CAP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000243", "type": "CDM"}, {"code": "68180065906", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RIGHT HEART CATH", "code_information": [{"code": "93451", "type": "CPT"}], "standard_charges": [{"minimum": 7513.23, "maximum": 7513.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7513.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RIGHT VENTRICULAR RECORDING", "code_information": [{"code": "93603", "type": "CPT"}], "standard_charges": [{"minimum": 19778.37, "maximum": 19778.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19778.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RILONACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2793", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RISPERDAL M-TAB (RISPERIDONE ODT) 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001155", "type": "CDM"}, {"code": "59746001032", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.02, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RISPERDAL TAB 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000440", "type": "CDM"}, {"code": "68382011314", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "RIV4 VACC RECOMBINANT DNA IM", "code_information": [{"code": "90682", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV BATTERY ONLY", "code_information": [{"code": "862T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV TRNSMTR ONLY", "code_information": [{"code": "863T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RLCJ PULSE GEN ONLY ISDSS", "code_information": [{"code": "681T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC ESP<100", "code_information": [{"code": "69727", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC>=100", "code_information": [{"code": "69728", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69726", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV PRSTC MTRL/MESH ABD WALL", "code_information": [{"code": "11008", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61892", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV&RPLC PM DUL W/L VNT LEAD", "code_information": [{"code": "C7540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BATTERY", "code_information": [{"code": "520T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BOTH", "code_information": [{"code": "519T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM LD", "code_information": [{"code": "33288", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM PG", "code_information": [{"code": "33287", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL & RPL CAR MODULJ PLS GN", "code_information": [{"code": "414T", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN 2 LEAD", "code_information": [{"code": "33263", "type": "CPT"}], "standard_charges": [{"minimum": 79417.32, "maximum": 79417.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 79417.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN MLT LD", "code_information": [{"code": "33264", "type": "CPT"}], "standard_charges": [{"minimum": 79417.32, "maximum": 79417.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 79417.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT TOT HRT SYS", "code_information": [{"code": "33928", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL ARTIFIC DISC ADDL CRVCL", "code_information": [{"code": "95T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62142", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL CAR MODULJ TRANVNS ELT", "code_information": [{"code": "413T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL CARDIAC MODULJ PLS GEN", "code_information": [{"code": "412T", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL DEEP RX DELIVERY DEVICE", "code_information": [{"code": "20701", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL ESOPHGL SPHNCTR DEV", "code_information": [{"code": "43285", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL EXT FIXJ SYS UNDER ANES", "code_information": [{"code": "20694", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL FB UPPER ARM/ELBW DEEP", "code_information": [{"code": "24201", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL HPGLSL NSTIM ARY PG", "code_information": [{"code": "64584", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL I-ARTIC RX DELIVERY DEV", "code_information": [{"code": "20705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL IMED RX DELIVERY DEVICE", "code_information": [{"code": "20703", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLT VSTIBULAR DEV UNI", "code_information": [{"code": "726T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "447T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL INTACT BREAST IMPLANT", "code_information": [{"code": "19328", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL NINFCT MESH HERNIA RPR", "code_information": [{"code": "49623", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL OF SUBQ DEFIBRILLATOR", "code_information": [{"code": "33272", "type": "CPT"}], "standard_charges": [{"minimum": 22313.11, "maximum": 22313.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22313.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ LEFT HEART VAD", "code_information": [{"code": "33992", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ RIGHT HEART VAD", "code_information": [{"code": "33997", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BATTERY ONLY", "code_information": [{"code": "518T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BOTH COMPNT", "code_information": [{"code": "861T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM PG ONLY", "code_information": [{"code": "33280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM SYS", "code_information": [{"code": "33278", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33279", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PROSTHHUMRL&ULNAR CMPNT", "code_information": [{"code": "24160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL RPLCMT HRT SYS F/TRNSPL", "code_information": [{"code": "33929", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL RUPTURED BREAST IMPLANT", "code_information": [{"code": "19330", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL SINUS TARSI IMPLANT", "code_information": [{"code": "510T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL SKIN TAGS EA ADDL 10", "code_information": [{"code": "11201", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL SS IMPL DFB PG ONLY", "code_information": [{"code": "580T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33286", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL THYRD W/AUTOTRAN PARATH", "code_information": [{"code": "C7555", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL TIS XPNDR WO INSJ IMPLT", "code_information": [{"code": "11971", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL TONGS/HALO ANTHR INDIV", "code_information": [{"code": "20665", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22864", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22865", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL& REPLC PULSE GEN 1 LEAD", "code_information": [{"code": "33262", "type": "CPT"}], "standard_charges": [{"minimum": 79417.32, "maximum": 79417.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 79417.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL&RIMPLTJ ANT SGM IMPLT", "code_information": [{"code": "661T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL&RINSJ SINUS TARSI IMPLT", "code_information": [{"code": "511T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT IMPLT VSTBLR DEV", "code_information": [{"code": "727T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RN CARE EA 15 MIN HH/HOSPICE", "code_information": [{"code": "G0493", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RN CARE TRAIN/EDU IN HH", "code_information": [{"code": "G0495", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RN HOME CARE PER DIEM", "code_information": [{"code": "T1030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RN SERVICES UP TO 15 MINUTES", "code_information": [{"code": "T1002", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RN TELEPHONE CALLS TO DMP", "code_information": [{"code": "S0320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RNA TSTNG HEP C DOCD DONE", "code_information": [{"code": "3218F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RNA TSTNG HEPC VIR ORD/DOCD", "code_information": [{"code": "3265F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROBAXIN (METHOCARBAMOL) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000251", "type": "CDM"}, {"code": "50268052015", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ROBAXIN (METHOCARBAMOL) TAB 750MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001625", "type": "CDM"}, {"code": "00904705861", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ROBITUSSIN DM SYRP 100MG/10MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000408", "type": "CDM"}, {"code": "61787051508", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ROBITUSSIN SUGAR FREE SYRP 100MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000117", "type": "CDM"}, {"code": "54838011740", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ROBITUSSIN SYRP 100MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000411", "type": "CDM"}, {"code": "50090323600", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ROBOT LIN-RADSURG COM, FIRST", "code_information": [{"code": "G0339", "type": "HCPCS"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROBOTIC SURGICAL SYSTEM", "code_information": [{"code": "S2900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROBT LIN-RADSURG FRACTX 2-5", "code_information": [{"code": "G0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROCEPHIN 1 GM INJ", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J0696", "type": "HCPCS"}, {"code": "7000412", "type": "CDM"}, {"code": "25021010610", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROCEPHIN 1 GM/100ML 0.9%NS IVPB", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J0696", "type": "HCPCS"}, {"code": "72000793", "type": "CDM"}, {"code": "25021010610", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROCEPHIN 500 MG INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0696", "type": "HCPCS"}, {"code": "72000505", "type": "CDM"}, {"code": "00781320795", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROCEPHIN 500 MG/100ML 0.9% NS IVPB", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0696", "type": "HCPCS"}, {"code": "72000542", "type": "CDM"}, {"code": "00781320795", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROCEPHIN 750 MG/100ML 0.9%NS IVPB", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J0696", "type": "HCPCS"}, {"code": "72000962", "type": "CDM"}, {"code": "44567070125", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROCKLATAN OPHTH SOLN 0.02%-0.005%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001150", "type": "CDM"}, {"code": "70727052925", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 966.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ROCKY MOUNTAIN SPOTTED FEVER IgG", "code_information": [{"code": "86757", "type": "CPT"}, {"code": "1000034", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 22.25, "maximum": 103.11, "gross_charge": 114.57, "discounted_cash": 54.17, "estimated_discounted_cash": 114.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 91.65, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROCKY MOUNTAIN SPOTTED FEVER IgM", "code_information": [{"code": "86757", "type": "CPT"}, {"code": "1000254", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 22.25, "maximum": 103.11, "gross_charge": 114.57, "discounted_cash": 54.17, "estimated_discounted_cash": 114.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 91.65, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROLAPITANT, ORAL, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROMAZICON(FLUMAZENIL) 0.1MG/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000198", "type": "CDM"}, {"code": "00143978410", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 38.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ROOT AMPUTATION", "code_information": [{"code": "D3450", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROOT SURGERY EA ADD ROOT", "code_information": [{"code": "D3426", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROOT SURGERY MOLAR", "code_information": [{"code": "D3425", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROOT SURGERY PREMOLAR", "code_information": [{"code": "D3421", "type": "HCPCS"}], "standard_charges": [{"minimum": 812.3, "maximum": 812.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 812.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROPIVACAINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2795", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROTA VIRUS TEST ADENOVIRUS", "code_information": [{"code": "87425", "type": "CPT"}, {"code": "1000104", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.78, "maximum": 63.9, "gross_charge": 71.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTARY WING AIR MILEAGE", "code_information": [{"code": "A0436", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROTARY WING AIR TRANSPORT", "code_information": [{"code": "A0431", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROTAVIRUS ANTIBODY", "code_information": [{"code": "86759", "type": "CPT"}], "standard_charges": [{"minimum": 20.96, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROUT FOOT CARE PER VISIT", "code_information": [{"code": "S0390", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROUTINE FOOTCARE PT W LOPS", "code_information": [{"code": "G0247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROUTINE OPHTHALMOLOGICAL EXA", "code_information": [{"code": "S0620", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROUTINE OPHTHALMOLOGICAL EXA", "code_information": [{"code": "S0621", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 1 AREA 1 D IMG", "code_information": [{"code": "78800", "type": "CPT"}], "standard_charges": [{"minimum": 301.77, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 301.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 2+AREA 1+D IMG", "code_information": [{"code": "78801", "type": "CPT"}], "standard_charges": [{"minimum": 327.53, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 327.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 1 AREA", "code_information": [{"code": "78803", "type": "CPT"}], "standard_charges": [{"minimum": 456.38, "maximum": 3077.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 456.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3077.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 2 AREAS", "code_information": [{"code": "78831", "type": "CPT"}], "standard_charges": [{"minimum": 839.09, "maximum": 839.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 839.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 1", "code_information": [{"code": "78830", "type": "CPT"}], "standard_charges": [{"minimum": 576.72, "maximum": 576.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 576.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 2", "code_information": [{"code": "78832", "type": "CPT"}], "standard_charges": [{"minimum": 1090.85, "maximum": 1090.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1090.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 1 D IMG", "code_information": [{"code": "78802", "type": "CPT"}], "standard_charges": [{"minimum": 368.97, "maximum": 3077.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 368.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3077.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 2+D IMG", "code_information": [{"code": "78804", "type": "CPT"}], "standard_charges": [{"minimum": 772.97, "maximum": 3077.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 772.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3077.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP QUAN MEAS SINGLE AREA", "code_information": [{"code": "78835", "type": "CPT"}], "standard_charges": [{"minimum": 119.91, "maximum": 119.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 119.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP THERAPY UNLISTED PX", "code_information": [{"code": "79999", "type": "CPT"}], "standard_charges": [{"minimum": 996.92, "maximum": 996.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 996.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62143", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE REVJ GSTRST TRC", "code_information": [{"code": "43763", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPLC OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69730", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPLCM OI IMPLT SK TC ESP<100", "code_information": [{"code": "69719", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPLCMT A-VALVE TLCJ AUTOL PV", "code_information": [{"code": "33440", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPLCMT OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69717", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPLCMT TISS XPNDR PERM IMPLT", "code_information": [{"code": "11970", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR", "code_information": [{"code": "86592", "type": "CPT"}, {"code": "1000113", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 4.91, "maximum": 33.38, "gross_charge": 25.26, "discounted_cash": 54.17, "estimated_discounted_cash": 28.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST 3-10 NCR/STRN", "code_information": [{"code": "49594", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST 3-10 RDC", "code_information": [{"code": "49593", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST < 3 CM RDC", "code_information": [{"code": "49591", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST < 3 NCR/STRN", "code_information": [{"code": "49592", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 NCR/STRN", "code_information": [{"code": "49596", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 RDC", "code_information": [{"code": "49595", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 NCR/STRN", "code_information": [{"code": "49616", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 RDC", "code_information": [{"code": "49615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 NCR/STRN", "code_information": [{"code": "49614", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 RDC", "code_information": [{"code": "49613", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 NCR/STRN", "code_information": [{"code": "49618", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 RDC", "code_information": [{"code": "49617", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA NTRANASL", "code_information": [{"code": "30540", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA TRSNPLTN", "code_information": [{"code": "30545", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR FEM HERNIA INIT BLOCKED", "code_information": [{"code": "49553", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR HERN PREEMIE REDUC", "code_information": [{"code": "49491", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP DSJ & URTP", "code_information": [{"code": "54348", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP SIMPLE", "code_information": [{"code": "54340", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR ING HERN PREMIE BLOCKED", "code_information": [{"code": "49492", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY BLOCKED", "code_information": [{"code": "49496", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY REDUC", "code_information": [{"code": "49495", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT BLOCKED", "code_information": [{"code": "49501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT REDUCE", "code_information": [{"code": "49500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH VERMILION ONLY", "code_information": [{"code": "40650", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH<HALF VER HEIGHT", "code_information": [{"code": "40652", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH>1HALF VER HT/CPX", "code_information": [{"code": "40654", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/IMPLT", "code_information": [{"code": "30468", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/RMDLG", "code_information": [{"code": "30469", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HERNIA RDC", "code_information": [{"code": "49621", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HRNA NCR/STRN", "code_information": [{"code": "49622", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR PUL ART UNIFOCAL W/O CPB", "code_information": [{"code": "33925", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR REM HERNIA INIT REDUCE", "code_information": [{"code": "49550", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR TDN/MUSC UPR A/E EACH", "code_information": [{"code": "24341", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR&REFIT SPCT PRSTH APHAKIA", "code_information": [{"code": "92371", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR&REFITG SPECT XCP APHAKIA", "code_information": [{"code": "92370", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPRDTVE MED RNA GEN PRFL 238", "code_information": [{"code": "253U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPRT BONE SCINT XREF W XRAY", "code_information": [{"code": "3570F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPT DOC CLASS HISTO TYPE", "code_information": [{"code": "G9422", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPT WO IMP/CON MMR/MSI", "code_information": [{"code": "M1195", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPTS W/ IMP/CON MMR/MSI", "code_information": [{"code": "M1193", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RRP HYPSPAD COMP MOBLJ&URTP", "code_information": [{"code": "54344", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSA LOWER EXTR EXAM", "code_information": [{"code": "350T", "type": "CPT"}], "standard_charges": [{"minimum": 182.71, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSA SPINE EXAM", "code_information": [{"code": "348T", "type": "CPT"}], "standard_charges": [{"minimum": 182.71, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSA UPPER EXTR EXAM", "code_information": [{"code": "349T", "type": "CPT"}], "standard_charges": [{"minimum": 182.71, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSECT HIP TUM INCL FEMUR", "code_information": [{"code": "27078", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSK FX REF W/N 24 HRS XRAY", "code_information": [{"code": "5100F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSN NO TRTMT CHEM HER2", "code_information": [{"code": "G2207", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV", "code_information": [{"code": "87420", "type": "CPT"}, {"code": "1000227", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.0, "maximum": 87.73, "gross_charge": 71.01, "discounted_cash": 54.17, "estimated_discounted_cash": 71.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV ASSAY W/OPTIC", "code_information": [{"code": "87807", "type": "CPT"}], "standard_charges": [{"minimum": 15.07, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV DNA/RNA AMP PROBE", "code_information": [{"code": "87634", "type": "CPT"}], "standard_charges": [{"minimum": 80.73, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 80.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV MAB IM 50MG", "code_information": [{"code": "90378", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN .5ML IM", "code_information": [{"code": "90380", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN 1 ML IM", "code_information": [{"code": "90381", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV VACC MRNA LIPID NANO IM", "code_information": [{"code": "90683", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF BIVALENT IM", "code_information": [{"code": "90678", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF RECOMB ADJT IM", "code_information": [{"code": "90679", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RTA POLARIZE SCAN OC SCR BI", "code_information": [{"code": "469T", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RUBELLA ANTIBODIES IgG", "code_information": [{"code": "86762", "type": "CPT"}, {"code": "1000352", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.55, "maximum": 76.68, "gross_charge": 85.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 76.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBELLA ANTIBODIES IgM", "code_information": [{"code": "86762", "type": "CPT"}, {"code": "1000353", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.55, "maximum": 76.68, "gross_charge": 85.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 76.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 48.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBEOLA AG IF", "code_information": [{"code": "87283", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 69.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 69.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RUBEOLA ANTIBODIES IgG", "code_information": [{"code": "86765", "type": "CPT"}, {"code": "1000354", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.81, "maximum": 68.63, "gross_charge": 76.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBEOLA ANTIBODIES IgM", "code_information": [{"code": "86765", "type": "CPT"}, {"code": "1000355", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.81, "maximum": 68.63, "gross_charge": 76.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUNX1 GENE TARGETED SEQ ALYS", "code_information": [{"code": "81334", "type": "CPT"}], "standard_charges": [{"minimum": 378.94, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 378.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RUSSELL VIPER VENOM DILUTED", "code_information": [{"code": "85613", "type": "CPT"}], "standard_charges": [{"minimum": 11.02, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RV1 VACC 2 DOSE LIVE ORAL", "code_information": [{"code": "90681", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RV5 VACC 3 DOSE LIVE ORAL", "code_information": [{"code": "90680", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RVW MEDS BY RX/DR IN RCRD", "code_information": [{"code": "1160F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX ACE OR ARB THERAPY", "code_information": [{"code": "G8935", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX ASY PRSMV 30+RX/METABLT", "code_information": [{"code": "227U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB ADVRS TRGT SEQ ALYS", "code_information": [{"code": "29U", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB ADVRS VRNT ALYS 25", "code_information": [{"code": "434U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB ADVRS VRNT ALYS 33", "code_information": [{"code": "438U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB GEN SEQ ALYS PNL 6", "code_information": [{"code": "81418", "type": "CPT"}], "standard_charges": [{"minimum": 1054.64, "maximum": 1054.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1054.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB GENRX IA 16 GENES", "code_information": [{"code": "392U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB WARF TRGT SEQ ALYS", "code_information": [{"code": "30U", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB/PCX DNA 16 GEN ALYS", "code_information": [{"code": "347U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB/PCX DNA 25 GEN ALYS", "code_information": [{"code": "348U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB/PCX DNA 27 GEN ALYS", "code_information": [{"code": "350U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX METAB/PCX DNA 27GEN RX IA", "code_information": [{"code": "349U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX MNTR 1+ORAL ONC RX&SBSTS", "code_information": [{"code": "110U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX MNTR 14+ DRUGS & SBSTS", "code_information": [{"code": "54U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX MNTR 65 COM DRUGS URINE", "code_information": [{"code": "93U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX MNTR LC-MS/MS ORAL FLUID", "code_information": [{"code": "11U", "type": "CPT"}], "standard_charges": [{"minimum": 33.57, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX MNTR LC-MS/MS UR/BLD 31", "code_information": [{"code": "51U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX MNTR NZM IA 35+ORAL FLU", "code_information": [{"code": "116U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX TEST DEF 90+ RX/SBSTS UR", "code_information": [{"code": "82U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RX TEST PRSMV UR W/DEF CONF", "code_information": [{"code": "7U", "type": "CPT"}], "standard_charges": [{"minimum": 102.04, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RXT BREAST APPL PLACE/REMOV", "code_information": [{"code": "C9726", "type": "HCPCS"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RYTHMOL ER CAP 425MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000952", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Rampart DL matrix, per square centimeter", "code_information": [{"code": "Q4347", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Rare diseases (constitutional disease/hereditary disorders), rapid whole genome and mitochondrial DNA sequencing for single-nucleotide variants, insertions/deletions, copy number variations, peripheral blood, buffy coat, saliva, buccal or tissue sample, r", "code_information": [{"code": "532U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Rare diseases (constitutional/heritable disorders), identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping", "code_information": [{"code": "454U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Rare diseases (constitutional/heritable disorders), whole genome sequence analysis for chromosomal abnormalities, copy number variants, duplications/deletions, inversions, unbalanced translocations, regions of homozygosity (ROH), inheritance pattern that ", "code_information": [{"code": "469U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Rare diseases (constitutional/heritable disorders), whole-genome sequence analysis combination of short and long reads, for single-nucleotide variants, insertions/deletions and characterized intronic variants, copy-number variants, duplications/deletions,", "code_information": [{"code": "567U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Receptor sole for use with L8720, replacement, each", "code_information": [{"code": "L8721", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Recommended follow-up interval for repeat colonoscopy of 10 years documented  in colonoscopy report and communicated with patient", "code_information": [{"code": "M1377", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Red blood cell antigen (fetal RhD gene analysis), next-generation sequencing of circulating cell-free DNA (cfDNA) of blood in pregnant individuals known to be RhD negative, reported as positive or negative", "code_information": [{"code": "494U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Red blood cell antigen (fetal RhD), PCR analysis of exon 4 of RHD gene and housekeeping control gene GAPDH from whole blood in pregnant individuals at 10+ weeks gestation known to be RhD negative, reported as fetal RhD status", "code_information": [{"code": "536U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Red blood cells, leukocytes reduced, oxygen/ carbon dioxide reduced, each unit", "code_information": [{"code": "P9027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Reeva FT, per square cenitmeter", "code_information": [{"code": "Q4314", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RegeneLink amniotic membrane allograft, per square centimeter", "code_information": [{"code": "Q4315", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Rehab sys active assist rt", "code_information": [{"code": "E0739", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Relocation of skin pocket for implanted cardiac contractility modulation-defibrillation pulse generator", "code_information": [{"code": "925T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Remote monitoring of a wireless left atrial pressure sensor for up to 30 days, including data from daily uploads of left atrial pressure recordings, interpretation(s) and trend analysis, with adjustments to the diuretics plan, treatment paradigm threshold", "code_information": [{"code": "934T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Remote monitoring of an implanted inferior vena cava sensor for up to 30 days, including at least weekly downloads of inferior vena cava area recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care profes", "code_information": [{"code": "983T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Remote monitoring of implantable inferior vena cava pressure sensor, physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial set-up and patient education on use of equipment", "code_information": [{"code": "982T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal and replacement of permanent cardiac contractility modulation-defibrillation pulse generator only", "code_information": [{"code": "923T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal of a peritoneal ascites pump system, including implanted peritoneal ascites pump and indwelling bladder and peritoneal catheters", "code_information": [{"code": "874T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal of a permanent cardiac contractility modulation-defibrillation system component(s); dual (pacing and defibrillation) transvenous leads only", "code_information": [{"code": "922T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal of a permanent cardiac contractility modulation-defibrillation system component(s); pulse generator only", "code_information": [{"code": "919T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal of a permanent cardiac contractility modulation-defibrillation system component(s); single transvenous defibrillation lead only", "code_information": [{"code": "921T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal of a permanent cardiac contractility modulation-defibrillation system component(s); single transvenous pacing lead only", "code_information": [{"code": "920T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal of epicranial neurostimulator system", "code_information": [{"code": "969T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal of integrated neurostimulation system, vagus nerve", "code_information": [{"code": "910T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal of sub-scalp implanted electrode array, receiver, and telemetry unit for continuous bilateral electroencephalography monitoring system, including imaging guidance", "code_information": [{"code": "958T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal or replacement of magnet from coil assembly that is connected to continuous bilateral electroencephalography monitoring system, including imaging guidance", "code_information": [{"code": "959T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal sutr/stapl xreq anes", "code_information": [{"code": "99211", "type": "CPT"}, {"code": "11001359", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 28.86, "maximum": 45.57, "gross_charge": 50.64, "discounted_cash": 54.17, "estimated_discounted_cash": 155.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 37.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 40.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 45.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 28.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Renew FT Matrix, per square centimeter", "code_information": [{"code": "Q4378", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RenoGraft, per square centimeter", "code_information": [{"code": "Q4321", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s) les", "code_information": [{"code": "C7565", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Replacement of a subcutaneous peritoneal ascites pump, including reconnection between pump and indwelling bladder and peritoneal catheters, including initial programming and imaging, when performed", "code_information": [{"code": "871T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Replacement of indwelling bladder and peritoneal catheters, including tunneling of catheter(s) and connection with previously implanted peritoneal ascites pump, including imaging and programming, when performed", "code_information": [{"code": "872T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Replacement of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed", "code_information": [{"code": "909T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Replacement of sub-scalp implanted electrode array, receiver, and telemetry unit with tunneling of electrode for continuous bilateral electroencephalography monitoring system, including imaging guidance", "code_information": [{"code": "960T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power", "code_information": [{"code": "L6031", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Repositioning of previously implanted cardiac contractility modulation-defibrillation transvenous electrode(s)/lead(s), including fluoroscopic guidance and programming of sensing and therapeutic parameters", "code_information": [{"code": "924T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Reproductive medicine (preimplantation genetic assessment), analysis for known genetic disorders from trophectoderm biopsy, linkage analysis of disease-causing locus, and when possible, targeted mutation analysis for known familial variant, reported as lo", "code_information": [{"code": "552U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, and a mitochondrial DNA score, results reported as normal/ba", "code_information": [{"code": "553U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, ploidy, a mitochondrial DNA score, and embryo quality contro", "code_information": [{"code": "555U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from trophectoderm biopsy for aneuploidy, ploidy, a mitochondrial DNA score, and embryo quality control, results reported as normal ", "code_information": [{"code": "554U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Respiratory syncytial virus, monoclonal antibody, seasonal dose, 0.7 mL, for intramuscular use", "code_information": [{"code": "90382", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Restoril (NF-Temazepam) Cap 7.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002249", "type": "CDM"}, {"code": "00904643604", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Restrata minimatrix, 5 mg", "code_information": [{"code": "A2026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Revision of a subcutaneously implanted peritoneal ascites pump system, any component (ascites pump, associated peritoneal catheter, associated bladder catheter), including imaging and programming, when performed", "code_information": [{"code": "873T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Revision of sub-scalp implanted electrode array, receiver, and telemetry unit for electrode, when required, including imaging guidance", "code_information": [{"code": "957T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Rheumatoid factor IgA and IgM, cyclic citrullinated peptide (CCP) antibodies, and scavenger receptor A (SR-A) by immunoassay, blood", "code_information": [{"code": "521U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Rocuronium Bromide IV Soln 10MG/1ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003607", "type": "CDM"}, {"code": "00409955810", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 21.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Rotary peristaltic infusion pump (e.g., ambIT pump), including catheter and all disposable system components, non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 ", "code_information": [{"code": "C9806", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Rpr intst excl anrect fist", "code_information": [{"code": "C9796", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "S BOWEL ENDOSCOPE W/STENT", "code_information": [{"code": "44379", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "S&I STENT/CHEST VERT ART", "code_information": [{"code": "76T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SACITUZUMAB GOVITECAN-HZIY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9317", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SACRAL NERVE STIM TEST LEAD", "code_information": [{"code": "A4290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SAFETY COUNSELING DEM ORDER", "code_information": [{"code": "6102F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SAFETY COUNSELING DEMENTIA", "code_information": [{"code": "6101F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SAFETY EQUIPMENT", "code_information": [{"code": "E0700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SAFETY FRAMES", "code_information": [{"code": "S0516", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SAFTY CNCRNS SCRN AND NEG", "code_information": [{"code": "G9923", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SALES TAX", "code_information": [{"code": "D9985", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SALES TAX", "code_information": [{"code": "S9999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SALICYLATES", "code_information": [{"code": "80329", "type": "CPT"}, {"code": "1000197", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 107.81, "gross_charge": 119.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 95.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 107.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALINE NASAL SPRAY 0.65%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000340", "type": "CDM"}, {"code": "24385032558", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.77, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3650", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3652", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND FUNCTION EXAM", "code_information": [{"code": "78232", "type": "CPT"}], "standard_charges": [{"minimum": 129.9, "maximum": 129.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 129.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND IMAGING", "code_information": [{"code": "78230", "type": "CPT"}], "standard_charges": [{"minimum": 209.88, "maximum": 209.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 209.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND PROCEDURES", "code_information": [{"code": "139", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SALMONELLA ANTIBODY", "code_information": [{"code": "86768", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SALSALATE TAB 750MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000246", "type": "CDM"}, {"code": "10135040401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SAME DAY NB DISCHARGE", "code_information": [{"code": "99463", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SAME PATH/DERM PERF BIOPSY", "code_information": [{"code": "G9939", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SANTYL (COLLAGENASE) OINT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000417", "type": "CDM"}, {"code": "50484001090", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 929.37, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SANTYL OINTMENT", "code_information": [{"code": "3000284", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SAQUINAVIR, 200 MG", "code_information": [{"code": "S0140", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARGRAMOSTIM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2820", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 ANTB QUANTITATIVE", "code_information": [{"code": "86413", "type": "CPT"}], "standard_charges": [{"minimum": 42.13, "maximum": 42.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID-19 ANTIBODY", "code_information": [{"code": "86769", "type": "CPT"}], "standard_charges": [{"minimum": 42.13, "maximum": 42.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID19 W/OPTIC", "code_information": [{"code": "87811", "type": "CPT"}], "standard_charges": [{"minimum": 41.38, "maximum": 41.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCOV & INF VIR A&B AG IA", "code_information": [{"code": "87428", "type": "CPT"}], "standard_charges": [{"minimum": 73.49, "maximum": 73.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 73.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 & INF A&B AMP PRB", "code_information": [{"code": "87636", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 142.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 25 MCG/.25ML IM", "code_information": [{"code": "91321", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 3MCG TRS-SUC IM", "code_information": [{"code": "91318", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 50 MCG/0.5ML IM", "code_information": [{"code": "91322", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 5MCG/0.5ML IM", "code_information": [{"code": "91304", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCOV2&INF A&B&RSV AMP PRB", "code_information": [{"code": "87637", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 142.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 10MCG TRS-SUC IM", "code_information": [{"code": "91319", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 30MCG TRS-SUC IM", "code_information": [{"code": "91320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SATISFY WITH CARE", "code_information": [{"code": "G0916", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SB CONTINUOUS PULSE OXIMETRY", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "11000285", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 166.12, "maximum": 368.06, "gross_charge": 408.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 306.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 327.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 368.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 233.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBRT DELIVERY", "code_information": [{"code": "77373", "type": "CPT"}], "standard_charges": [{"minimum": 584.0, "maximum": 1607.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1607.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 584.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBRT MANAGEMENT", "code_information": [{"code": "77435", "type": "CPT"}], "standard_charges": [{"minimum": 1008.55, "maximum": 1084.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1084.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS HIGH 50", "code_information": [{"code": "99233", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS MODERATE 35", "code_information": [{"code": "99232", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS SF/LOW 25", "code_information": [{"code": "99231", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ NB EM PER DAY HOSP", "code_information": [{"code": "99462", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE HIGH MDM 45", "code_information": [{"code": "99310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE LOW MDM 20", "code_information": [{"code": "99308", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE MODERATE MDM 30", "code_information": [{"code": "99309", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE SF MDM 10", "code_information": [{"code": "99307", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ PSYC COLLAB CARE MGMT", "code_information": [{"code": "99493", "type": "CPT"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQT PLMT DRUG ELUT OC INS", "code_information": [{"code": "445T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SC DIS P-SELECTIN WHL BLOOD", "code_information": [{"code": "122U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SC DIS VCAM-1 WHOLE BLOOD", "code_information": [{"code": "121U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SC GNOTYP ERMAP EXONS 4 12", "code_information": [{"code": "199U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION ADDL HR", "code_information": [{"code": "96370", "type": "CPT"}], "standard_charges": [{"minimum": 1636.8, "maximum": 1636.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1636.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION RESET PUMP", "code_information": [{"code": "96371", "type": "CPT"}], "standard_charges": [{"minimum": 966.98, "maximum": 966.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION UP TO 1 HR", "code_information": [{"code": "96369", "type": "CPT"}], "standard_charges": [{"minimum": 966.98, "maximum": 966.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCALE & DEBRIDE, SINGLE IMP", "code_information": [{"code": "D6081", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCALE, EACH", "code_information": [{"code": "E1639", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCALING GINGIV INFLAMMATION", "code_information": [{"code": "D4346", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCALP COOL 1ST MEAS&CALBRJ", "code_information": [{"code": "662T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCALP COOL PLMT MNTR RMVL", "code_information": [{"code": "663T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL EXTRA", "code_information": [{"code": "61782", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL INTRA", "code_information": [{"code": "61781", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCAN PROC SPINAL", "code_information": [{"code": "61783", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCAPEL DISP #10", "code_information": [{"code": "3000533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCAPEL DISP #11", "code_information": [{"code": "3000534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCAPEL DISP #15", "code_information": [{"code": "3000535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCHOOL-BASED IEP SER BUNDLED", "code_information": [{"code": "T1018", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCINTIMAMMOGRAPHY", "code_information": [{"code": "S8080", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.54, "maximum": 161.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCISSORS", "code_information": [{"code": "80000300", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 0.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCLERAL LENS LIQUID BANDAGE", "code_information": [{"code": "S0515", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCLEROTX FLUID COLLECTION", "code_information": [{"code": "49185", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCOLIOSIS DNA ALYS", "code_information": [{"code": "4M", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCOPE PLANTAR FASCIOTOMY", "code_information": [{"code": "29893", "type": "CPT"}], "standard_charges": [{"minimum": 6884.6, "maximum": 6884.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6884.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCOPOLAMINE TRANSDERM PATCH 1.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000464", "type": "CDM"}, {"code": "50742050504", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 29.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCOTCHCAST PLUS CASTING 2", "code_information": [{"code": "3001252", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 10.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCOTCHCAST PLUS CASTING 3", "code_information": [{"code": "3001253", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.96, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCOTCHCAST PLUS CASTING 4", "code_information": [{"code": "3001254", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 9.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOMATED SYS", "code_information": [{"code": "G0147", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOSYS, RESCR", "code_information": [{"code": "G0148", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,AUTOSYS AND MD", "code_information": [{"code": "G0141", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0143", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0144", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR DEP NEG, NO PLAN REQD", "code_information": [{"code": "G8510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR DEP POS, NO PLAN DOC RNG", "code_information": [{"code": "G8511", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR FOR DEP NOT CPT DOC RSN", "code_information": [{"code": "G8433", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCR UNHEAL ETOH W/COUNSEL", "code_information": [{"code": "G9621", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREEN C/V THIN LAYER BY MD", "code_information": [{"code": "G0124", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREEN CERV/VAG THIN LAYER", "code_information": [{"code": "G0123", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREEN DEPRESSION PERFORMED", "code_information": [{"code": "3725F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREEN HLTHY ETOH USE", "code_information": [{"code": "G2197", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREEN MAMMO DOC REV", "code_information": [{"code": "3014F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREEN PAP BY TECH W MD SUPV", "code_information": [{"code": "P3000", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREEN UNHLTHY ETOH USE", "code_information": [{"code": "G2196", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREENING OF A PATIENT", "code_information": [{"code": "D0190", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREENING PAP SMEAR BY PHYS", "code_information": [{"code": "P3001", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.12, "maximum": 55.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREENING PROCTOSCOPY", "code_information": [{"code": "S0601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREENING SLEEP DISORDERS", "code_information": [{"code": "D9957", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREENING TESTS DM DONE", "code_information": [{"code": "3754F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCREW RETAINED PLATE", "code_information": [{"code": "D7292", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCRN HCV INFEC NOT RECD", "code_information": [{"code": "G9386", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCRN MAM PERF RSLTS DOC", "code_information": [{"code": "G9899", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCRN MAM PERF RSLTS DOC", "code_information": [{"code": "M1302", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCRN MAM PERF RSLTS NOT DOC", "code_information": [{"code": "G9900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCRN MAM PERF RSLTS NOT DOC", "code_information": [{"code": "M1285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCRN ND POS ND PROV OF REC", "code_information": [{"code": "G9919", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCRNING PERF AND NEGATIVE", "code_information": [{"code": "G9920", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCROTAL SUPPORT L", "code_information": [{"code": "3000285", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SCROTAL SUPPORT M", "code_information": [{"code": "3000286", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEA SORB ALGINATE FILLER ROPE", "code_information": [{"code": "3000288", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEALANT REPAIR PER TOOTH", "code_information": [{"code": "D1353", "type": "HCPCS"}], "standard_charges": [{"minimum": 133.32, "maximum": 133.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 133.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEALANT, PULMONARY, LIQUID", "code_information": [{"code": "C2615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEAT LIFT MECHANISM TOILET", "code_information": [{"code": "E0172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEAT/BACK CUS NO DMEPDAC VER", "code_information": [{"code": "K0669", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEC ART THROMBECTOMY ADD-ON", "code_information": [{"code": "37186", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEC CLSR SURG WND/DEHSN XTN", "code_information": [{"code": "13160", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SECOND STAGE IMPLANT SURGERY", "code_information": [{"code": "D6011", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SECTRAL (ACEBUTOLOL) TAB 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000522", "type": "CDM"}, {"code": "53746066901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEDATION (NON-IV)", "code_information": [{"code": "D9248", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEDATIVE HYPNOTICS", "code_information": [{"code": "80368", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEDIMENTATION RATE", "code_information": [{"code": "85651", "type": "CPT"}, {"code": "1000090", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.91, "maximum": 18.9, "gross_charge": 21.0, "discounted_cash": 54.17, "estimated_discounted_cash": 21.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEG ACET AND ETH ESTR YEARLY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7294", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEGMENTECTOMY", "code_information": [{"code": "32484", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEIZURE TYPE& FREQU DOCD", "code_information": [{"code": "1200F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITH MCC", "code_information": [{"code": "100", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITHOUT MCC", "code_information": [{"code": "101", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SELECT PICTURE AUDIOMETRY", "code_information": [{"code": "92583", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SELF CARE MNGMENT TRAINING", "code_information": [{"code": "97535", "type": "CPT"}], "standard_charges": [{"minimum": 30.94, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SELF-CARE ED PROVIDED TO PT", "code_information": [{"code": "4450F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SELF-HELP/PEER SVC PER 15MIN", "code_information": [{"code": "H0038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SELF-MEAS BP 2 READG BID 30D", "code_information": [{"code": "99474", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SELF-MEAS BP PT EDUCAJ/TRAIN", "code_information": [{"code": "99473", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC & TRAIN 1 PT", "code_information": [{"code": "98960", "type": "CPT"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC/TRAIN 2-4 PT", "code_information": [{"code": "98961", "type": "CPT"}], "standard_charges": [{"minimum": 146.67, "maximum": 146.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 146.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC/TRAIN 5-8 PT", "code_information": [{"code": "98962", "type": "CPT"}], "standard_charges": [{"minimum": 146.67, "maximum": 146.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 146.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL SPERM DETECTION", "code_information": [{"code": "89321", "type": "CPT"}], "standard_charges": [{"minimum": 13.86, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL STRICT CRITERIA", "code_information": [{"code": "89322", "type": "CPT"}], "standard_charges": [{"minimum": 17.83, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL VOL/COUNT/MOT", "code_information": [{"code": "89320", "type": "CPT"}], "standard_charges": [{"minimum": 14.16, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS", "code_information": [{"code": "G0027", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS W/COUNT", "code_information": [{"code": "89310", "type": "CPT"}], "standard_charges": [{"minimum": 9.9, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS W/HUHNER", "code_information": [{"code": "89300", "type": "CPT"}], "standard_charges": [{"minimum": 11.32, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEMI PRECISION ABUTMENT", "code_information": [{"code": "D6191", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEMI PRECISION ATTACHMENT", "code_information": [{"code": "D6192", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEN LYM P NODE BIOP NOT PERF", "code_information": [{"code": "G8880", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SENNA-S (DOCUSATE SOD) TAB 8.6/50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000418", "type": "CDM"}, {"code": "00904744061", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SENSORIMOTOR EXAMINATION", "code_information": [{"code": "92060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SENSORINEURAL ACUITY TEST", "code_information": [{"code": "92575", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SENSORY INTEGRATION", "code_information": [{"code": "97533", "type": "CPT"}], "standard_charges": [{"minimum": 59.37, "maximum": 589.34, "discounted_cash": 54.17, "estimated_discounted_cash": 188.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SENT LYMPH NODE BIOPSY", "code_information": [{"code": "G8878", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEPARATE EYELID ADHESIONS", "code_information": [{"code": "68340", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEPT9 GEN PRMTR MTHYLTN ALYS", "code_information": [{"code": "81327", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 220.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 220.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEPTAL DEFECT IMP SYS", "code_information": [{"code": "C1817", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH CC", "code_information": [{"code": "549", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [{"code": "548", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITHOUT CC/MCC", "code_information": [{"code": "550", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [{"code": "870", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [{"code": "871", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [{"code": "872", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY OLECRN PROCES", "code_information": [{"code": "24138", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY RADIAL H/N", "code_information": [{"code": "24136", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY SHFT/DSTL HUM", "code_information": [{"code": "24134", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEREVENT DISKUS (SALMETEROL) INH 50MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000419", "type": "CDM"}, {"code": "00173052100", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 1134.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SERIAL SALIVARY IMAGING", "code_information": [{"code": "78231", "type": "CPT"}], "standard_charges": [{"minimum": 132.23, "maximum": 132.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 132.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERIAL TONOMETRY", "code_information": [{"code": "92100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERMORELIN ACETATE INJECTION", "code_information": [{"code": "Q0515", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEROQUEL (QUETIAPINE) ER TAB 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000476", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEROQUEL (QUETIAPINE) SUSP. 50MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001074", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEROQUEL (QUETIAPINE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000421", "type": "CDM"}, {"code": "60687034901", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEROQUEL (QUETIAPINE) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000420", "type": "CDM"}, {"code": "67877024210", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEROTONIN", "code_information": [{"code": "84260", "type": "CPT"}, {"code": "1000023", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.63, "maximum": 165.02, "gross_charge": 183.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 35.63, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 146.68, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 165.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 104.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERPINA1 GENE", "code_information": [{"code": "81332", "type": "CPT"}], "standard_charges": [{"minimum": 50.2, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERUM CLOTTING TIME TUBE", "code_information": [{"code": "A4771", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERUM IMMUNOELECTROPHORESIS", "code_information": [{"code": "86320", "type": "CPT"}], "standard_charges": [{"minimum": 34.41, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERUM LVLS CA/IPTH/LPD ORD", "code_information": [{"code": "3278F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERUM OSMOLALITY", "code_information": [{"code": "83930", "type": "CPT"}, {"code": "1000464", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.6, "maximum": 40.5, "gross_charge": 45.0, "discounted_cash": 54.17, "estimated_discounted_cash": 45.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERUM PROTEIN ELECTROPH W/INTERPRETAION", "code_information": [{"code": "84155", "type": "CPT"}, {"code": "1000960", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.22, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "estimated_discounted_cash": 21.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERUM PROTEIN ELECTROPHORESIS", "code_information": [{"code": "84165", "type": "CPT"}, {"code": "1000360", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.35, "maximum": 57.21, "gross_charge": 63.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 57.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERV ASMNT/CARE PLAN WAIVER", "code_information": [{"code": "T2024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERV PART OF PHASE I TRIAL", "code_information": [{"code": "S9988", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES OUTSIDE US", "code_information": [{"code": "S9989", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES PROVIDED AS PART OF", "code_information": [{"code": "S9990", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES PROVIDED AS PART OF", "code_information": [{"code": "S9991", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES PROVIDED IN URGENT", "code_information": [{"code": "S9088", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERZONE LEVEL", "code_information": [{"code": "80338", "type": "CPT"}, {"code": "1000289", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 98.1, "gross_charge": 109.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77280", "type": "CPT"}], "standard_charges": [{"minimum": 430.45, "maximum": 430.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 430.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77285", "type": "CPT"}], "standard_charges": [{"minimum": 710.88, "maximum": 710.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 710.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77290", "type": "CPT"}], "standard_charges": [{"minimum": 735.76, "maximum": 735.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 735.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SET UP PORT XRAY EQUIPMENT", "code_information": [{"code": "Q0092", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SET-UP CARDIOVERT-DEFIBRILL", "code_information": [{"code": "93745", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SET-UP FOOTREST", "code_information": [{"code": "3000289", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SET-UP TRACTION", "code_information": [{"code": "3000290", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SET-UP TRAPEZE", "code_information": [{"code": "3000291", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEVELAMER HCL 800MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001011", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SEVER CRANIAL NERVE", "code_information": [{"code": "64771", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEVERITY ANGINA BY ACTVTY", "code_information": [{"code": "1010F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88130", "type": "CPT"}], "standard_charges": [{"minimum": 20.68, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88140", "type": "CPT"}], "standard_charges": [{"minimum": 9.19, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEX HORMONE BINDING GLOBULIN", "code_information": [{"code": "84270", "type": "CPT"}, {"code": "1000792", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.99, "maximum": 108.78, "gross_charge": 120.87, "discounted_cash": 54.17, "estimated_discounted_cash": 120.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 96.69, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 108.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX OFFEND TX SVC, 15 MIN", "code_information": [{"code": "H2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEX OFFEND TX SVC, PER DIEM", "code_information": [{"code": "H2029", "type": "HCPCS"}], "standard_charges": [{"minimum": 973.08, "maximum": 973.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 973.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION F TO M", "code_information": [{"code": "55980", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION M TO F", "code_information": [{"code": "55970", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SF3B1 GENE COMMON VARIANTS", "code_information": [{"code": "81347", "type": "CPT"}], "standard_charges": [{"minimum": 222.24, "maximum": 222.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 222.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SFTY CNCRNS SCRN BUT NO RECS", "code_information": [{"code": "G9926", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SFTY CNCRNS SCRN ND MIT RECS", "code_information": [{"code": "G9922", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SGD ACCESSORY NOC", "code_information": [{"code": "E2599", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SGMDSC W/BAND LIGATION", "code_information": [{"code": "45350", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAMPOO CAP SAGE", "code_information": [{"code": "3001368", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11301", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11306", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11311", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11302", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11307", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11312", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11303", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11308", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11313", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHAVING CREAM", "code_information": [{"code": "3000292", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SHAVING EPIDERMAL/SKIN LESION (TECH)", "code_information": [{"code": "11305", "type": "CPT"}, {"code": "11000208", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 288.9, "maximum": 456.16, "gross_charge": 506.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 380.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 405.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 456.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 288.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHIGELLA ANTIBODY", "code_information": [{"code": "86771", "type": "CPT"}], "standard_charges": [{"minimum": 28.15, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS DX +- SYNOVIAL BX", "code_information": [{"code": "29805", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG BICP TENODSIS", "code_information": [{"code": "29828", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG CAPSULORRAPHY", "code_information": [{"code": "29806", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG COMPL SYNVCT", "code_information": [{"code": "29821", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG DECOMPRESSION", "code_information": [{"code": "29826", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG DSTL CLAVICLC", "code_information": [{"code": "29824", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG LMTD DBRDMT", "code_information": [{"code": "29822", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG LSS&RESCJ ADS", "code_information": [{"code": "29825", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG PRTL SYNVCT", "code_information": [{"code": "29820", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RMVL LOOSE/FB", "code_information": [{"code": "29819", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RPR SLAP LES", "code_information": [{"code": "29807", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RT8TR CUF RPR", "code_information": [{"code": "29827", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG XTNSV DBRDMT", "code_information": [{"code": "29823", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOE HEEL PAD REMOVABLE FOR", "code_information": [{"code": "L3485", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOE LIFT ELEV HEEL/SOLE COR", "code_information": [{"code": "L3320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOE MOLDED PLASTAZOTE CUST", "code_information": [{"code": "L3252", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOE MOLDED PLASTAZOTE CUST", "code_information": [{"code": "L3253", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOE MOLDED TO PT SILICONE S", "code_information": [{"code": "L3251", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOE STYLED POSITIONING DEV", "code_information": [{"code": "L3160", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS & ULNA", "code_information": [{"code": "25392", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS OR ULNA", "code_information": [{"code": "25390", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHORTEN/LENGTHEN THIGHS", "code_information": [{"code": "27468", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF HAND TENDON", "code_information": [{"code": "26479", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF THIGH BONE", "code_information": [{"code": "27465", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOULD SLING/VEST/ABRESTRAIN", "code_information": [{"code": "A4566", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOULDER JOINT SURGERY", "code_information": [{"code": "23101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23334", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23335", "type": "CPT"}], "standard_charges": [{"minimum": 5642.98, "maximum": 5642.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5642.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC", "code_information": [{"code": "511", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC", "code_information": [{"code": "510", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "512", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SHUNT ACCESSORY", "code_information": [{"code": "A4740", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIALIDASE ENZYME ASSAY", "code_information": [{"code": "87905", "type": "CPT"}], "standard_charges": [{"minimum": 14.05, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIALODOCHOPLASTY", "code_information": [{"code": "D7982", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIALOENDOSCOPY CAPT & INTERP", "code_information": [{"code": "D0371", "type": "HCPCS"}], "standard_charges": [{"minimum": 377.64, "maximum": 377.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 377.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIEP", "code_information": [{"code": "86334", "type": "CPT"}, {"code": "1000029", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 25.69, "maximum": 119.01, "gross_charge": 132.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 25.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 105.79, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 119.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 75.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIG W/TNDSC BALLOON DILATION", "code_information": [{"code": "45340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & DECOMPRESS", "code_information": [{"code": "45337", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & POLYPECTOMY", "code_information": [{"code": "45333", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY AND BIOPSY", "code_information": [{"code": "45331", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FOR BLEEDING", "code_information": [{"code": "45334", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ABLATION", "code_information": [{"code": "45346", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/FB REMOVAL", "code_information": [{"code": "45332", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/PLCMT STENT", "code_information": [{"code": "45347", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/RESECTION", "code_information": [{"code": "45349", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/SUBMUC INJ", "code_information": [{"code": "45335", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/TUMR REMOVE", "code_information": [{"code": "45338", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ULTRASOUND", "code_information": [{"code": "45341", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/US GUIDE BX", "code_information": [{"code": "45342", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGN LANG/ORAL INTERPRETER", "code_information": [{"code": "T1013", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGNATURE APATCH, PER SQ CM", "code_information": [{"code": "Q4260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "555", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [{"code": "556", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "947", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "948", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 3120.58, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SILDENAFIL CITRATE, 25 MG", "code_information": [{"code": "S0090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SILICONE GEL SHEET, EACH", "code_information": [{"code": "A6025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SILVASORB 6GM CAVITY ANTIMICR ABSRENT", "code_information": [{"code": "3001039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SILVASORB ANTIMICR CAVITY STRANDS 6GM", "code_information": [{"code": "3001040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SILVASORB SITE DRESSING 1", "code_information": [{"code": "3001370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SILVER SULFADIAZINE 1% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000456", "type": "CDM"}, {"code": "67877012405", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 26.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SIMETHICONE (PHAZYME) TAB 80MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000766", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SIMETHICONE 125MG CHEW. TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000881", "type": "CDM"}, {"code": "00536122308", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SIMETHICONE 80MG CHW.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002846", "type": "CDM"}, {"code": "00904720660", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SIMPLE CYSTOMETROGRAM", "code_information": [{"code": "51725", "type": "CPT"}], "standard_charges": [{"minimum": 1212.82, "maximum": 1212.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1212.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [{"code": "194", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 4417.48, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [{"code": "193", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 7352.25, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC", "code_information": [{"code": "195", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 3376.38, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SIMULT PANC KIDN TRANS", "code_information": [{"code": "S2065", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [{"code": "8", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [{"code": "19", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SINCALIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2805", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINEMET (CARBIDO/LEVADO) 10/100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000740", "type": "CDM"}, {"code": "00378007801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SINEMET (CARBIDO/LEVADO) CR 25/100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000514", "type": "CDM"}, {"code": "60687066101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SINEMET (CARBIDOPA /LEVODOPA) 25/100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000506", "type": "CDM"}, {"code": "60687066101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SINEQUAN (DOXEPIN) CAP 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000170", "type": "CDM"}, {"code": "00378312501", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SINEQUAN (DOXEPIN) CAP 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001013", "type": "CDM"}, {"code": "51079043820", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SINGL PRSCRP LENS", "code_information": [{"code": "S0504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINGLE ENERGY X-RAY STUDY", "code_information": [{"code": "G0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 253.28, "maximum": 253.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 253.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINGLE LENS SPECTACLE MOUNT", "code_information": [{"code": "V2610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL", "code_information": [{"code": "402", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE", "code_information": [{"code": "450", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC", "code_information": [{"code": "451", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SINGLE O2 SATURATION DETERMINATION", "code_information": [{"code": "94760", "type": "CPT"}, {"code": "4200007", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 4.87, "maximum": 7.69, "gross_charge": 8.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 6.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 4.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINGLE TRANSFER TOE-HAND", "code_information": [{"code": "26553", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINGLE VITAMIN NOS", "code_information": [{"code": "A9152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINGULAIR (MONTELUKAST) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000424", "type": "CDM"}, {"code": "00904680861", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITH CC/MCC", "code_information": [{"code": "135", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "136", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SINUS AUG W BONE OR BONE SUB", "code_information": [{"code": "D7951", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINUS AUGMENTATION VERTICAL", "code_information": [{"code": "D7952", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINUS CAUS BAC INX", "code_information": [{"code": "G9364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINUS RELIEF 1% NASAL SPRAY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001087", "type": "CDM"}, {"code": "59262024821", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SINUSOIDAL ROTATIONAL TEST", "code_information": [{"code": "92546", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIPULEUCEL-T AUTO CD54+", "code_information": [{"code": "Q2043", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIROLIMUS, ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SITE NO LUNG OR LUNG CX", "code_information": [{"code": "G9424", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SITE NOT SMALL CELL LUNG CA", "code_information": [{"code": "G9285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SJOGRENS ANTIBODIES", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "1000251", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.62, "maximum": 96.7, "gross_charge": 106.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 84.91, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKEL MUSC RELAXANT 3 OR MORE", "code_information": [{"code": "80370", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKELAXIN (METAXALONE) TAB 800MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000425", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 9.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SKELETAL MUSCLE RELAXANT 1/2", "code_information": [{"code": "80369", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKILL TRAIN AND DEV/DIEM", "code_information": [{"code": "H2038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKILLED NURSING FACILITY SS", "code_information": [{"code": "G4033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKILLS TRAIN AND DEV, 15 MIN", "code_information": [{"code": "H2014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN AND MUSCLE REPAIR FACE", "code_information": [{"code": "15845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN BARRIER /UROSTOMY/ 3704", "code_information": [{"code": "3001238", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.35, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH CC", "code_information": [{"code": "571", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [{"code": "570", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITHOUT CC/MCC", "code_information": [{"code": "572", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN FUNGI CULTURE", "code_information": [{"code": "87101", "type": "CPT"}], "standard_charges": [{"minimum": 8.87, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "577", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "576", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "578", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "574", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "573", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "575", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "623", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "622", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "624", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITH CC/MCC", "code_information": [{"code": "904", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "905", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP ARMS/LEGS", "code_information": [{"code": "15572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP TRUNK", "code_information": [{"code": "15570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN PEEL THERAPY", "code_information": [{"code": "17360", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN PREP WIPES", "code_information": [{"code": "3000294", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SKIN PROTECTANT BARRIER CREAM", "code_information": [{"code": "3001480", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SKIN REPAIR REMEDY CREAM (PURPLE TOP)", "code_information": [{"code": "3001422", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.54, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SKIN SEAL PROTECT MOISTURIZR", "code_information": [{"code": "A6250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT T/A/L ADD-ON", "code_information": [{"code": "15101", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT TRNK/ARM/LEG", "code_information": [{"code": "15100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SUB FDA CLRD AS DEV NOS", "code_information": [{"code": "A4100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT F/N/HF/G ADDL", "code_information": [{"code": "15276", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT FACE/NK/HF/G", "code_information": [{"code": "15275", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT T/A/L ADD-ON", "code_information": [{"code": "15272", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT TRNK/ARM/LEG", "code_information": [{"code": "15271", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRFT T/ARM/LG CHILD", "code_information": [{"code": "15273", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SUBSTITUTE, NOS", "code_information": [{"code": "Q4100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN TE 1 SQ CM", "code_information": [{"code": "Q4200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN TEST CANDIDA", "code_information": [{"code": "86485", "type": "CPT"}], "standard_charges": [{"minimum": 20.5, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN TEST UNLISTED ANTIGN EA", "code_information": [{"code": "86486", "type": "CPT"}], "standard_charges": [{"minimum": 6.37, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH CC", "code_information": [{"code": "593", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH MCC", "code_information": [{"code": "592", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITHOUT CC/MCC", "code_information": [{"code": "594", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT F/N/HF/G ADD", "code_information": [{"code": "15121", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT FAC/NCK/HF/G", "code_information": [{"code": "15120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CH ADD", "code_information": [{"code": "15278", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CHILD", "code_information": [{"code": "15277", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT T/A/L CHILD ADD", "code_information": [{"code": "15274", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61575", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61576", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKYLA, 13.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7301", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLCO1B1 GENE COM VARIANTS", "code_information": [{"code": "81328", "type": "CPT"}], "standard_charges": [{"minimum": 201.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9947", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEP APNEA ASSESS", "code_information": [{"code": "G8839", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY ATTENDED", "code_information": [{"code": "95807", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY UNATT&RESP EFFT", "code_information": [{"code": "95806", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEVE LOBECTOMY", "code_information": [{"code": "32486", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEVE PNEUMONECTOMY", "code_information": [{"code": "32442", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEVE, INTER LIMB COMP DEV", "code_information": [{"code": "A4600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/ANAL", "code_information": [{"code": "95801", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATTENDED", "code_information": [{"code": "95800", "type": "CPT"}], "standard_charges": [{"minimum": 2431.93, "maximum": 2431.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2431.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SM 153 LEXIDRONAM", "code_information": [{"code": "A9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL ANIMAL INOCULATION", "code_information": [{"code": "87003", "type": "CPT"}], "standard_charges": [{"minimum": 19.37, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44360", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44363", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44364", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44365", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44366", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44369", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44372", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44373", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44376", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44378", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44382", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44384", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44380", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44381", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44361", "type": "CPT"}], "standard_charges": [{"minimum": 3052.74, "maximum": 3052.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3052.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44377", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/STENT", "code_information": [{"code": "44370", "type": "CPT"}], "standard_charges": [{"minimum": 8145.67, "maximum": 8145.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8145.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL DISPOSABLE UNDERPAD", "code_information": [{"code": "T4542", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALLPOX&MONKEYPOX VAC 0.5ML", "code_information": [{"code": "90611", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMEAR WET MOUNT SALINE/INK", "code_information": [{"code": "87210", "type": "CPT"}], "standard_charges": [{"minimum": 6.69, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMMG CNCRNT APPL IMU SNR", "code_information": [{"code": "778T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMN1 GEN NOWN FAMIL SEQ VRNT", "code_information": [{"code": "81337", "type": "CPT"}], "standard_charges": [{"minimum": 212.98, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMN1 GENE DOS/DELETION ALYS", "code_information": [{"code": "81329", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMN1 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81336", "type": "CPT"}], "standard_charges": [{"minimum": 346.55, "maximum": 346.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 346.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMN1&SMN2 FULL GENE ANALYSIS", "code_information": [{"code": "236U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMOKELESS TOBACCO USER", "code_information": [{"code": "1035F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMOKER/EXPOSED 2ND HND SMOKE", "code_information": [{"code": "1032F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMOKING & 2ND HAND ASSESSED", "code_information": [{"code": "1031F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMOKING CESSATION CLASS", "code_information": [{"code": "S9453", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMOKING CESSATION GUM", "code_information": [{"code": "S4995", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMPD1 GENE COMMON VARIANTS", "code_information": [{"code": "81330", "type": "CPT"}], "standard_charges": [{"minimum": 54.05, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SNRPN/UBE3A GENE", "code_information": [{"code": "81331", "type": "CPT"}], "standard_charges": [{"minimum": 58.73, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO GSAP CL FR CPY NMBR&MCRST", "code_information": [{"code": "81463", "type": "CPT"}], "standard_charges": [{"minimum": 1547.11, "maximum": 1547.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1547.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO GSAP CLL FR DNA/DNA&RNA", "code_information": [{"code": "81462", "type": "CPT"}], "standard_charges": [{"minimum": 1375.21, "maximum": 1375.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1375.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO GSAP CLL FR MCRSTL INS", "code_information": [{"code": "81464", "type": "CPT"}], "standard_charges": [{"minimum": 3781.79, "maximum": 3781.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3781.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO GSAP DNA CPY NMBR&MCRSTL", "code_information": [{"code": "81458", "type": "CPT"}], "standard_charges": [{"minimum": 1203.3, "maximum": 1203.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1203.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO HARD PLAS STABILI PRE CST", "code_information": [{"code": "L3677", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO HARD PLAS STABILI PRE OTS", "code_information": [{"code": "L3678", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP 5-50 RNA ALYS", "code_information": [{"code": "81449", "type": "CPT"}], "standard_charges": [{"minimum": 699.55, "maximum": 699.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 699.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP 5-50DNA/DNA&RNA", "code_information": [{"code": "81445", "type": "CPT"}], "standard_charges": [{"minimum": 687.6, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 687.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP DNA MCRSTL INS", "code_information": [{"code": "81457", "type": "CPT"}], "standard_charges": [{"minimum": 1031.4, "maximum": 1031.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1031.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP DNA/DNA&RNA", "code_information": [{"code": "81459", "type": "CPT"}], "standard_charges": [{"minimum": 3437.99, "maximum": 3437.99, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3437.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO/HL 51/>GSAP DNA/DNA&RNA", "code_information": [{"code": "81455", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 3357.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3357.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO/HL 51/>GSAP RNA ALYS", "code_information": [{"code": "81456", "type": "CPT"}], "standard_charges": [{"minimum": 3415.93, "maximum": 3415.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3415.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOCIAL WORK VISIT, IN THE HO", "code_information": [{"code": "S9127", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOCKS NON-SKID 2XL GREY", "code_information": [{"code": "3001269", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SOCKS NON-SKID LARGE BLUE", "code_information": [{"code": "3000254", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SOCKS NON-SKID ORANGE", "code_information": [{"code": "3001428", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SOCKS NON-SKID ORANGE", "code_information": [{"code": "3001479", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SOCKS NON-SKID XL TAN", "code_information": [{"code": "3000051", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SOCKS NON-SKID XXXL YELLOW", "code_information": [{"code": "3001411", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM 24HR UR", "code_information": [{"code": "84300", "type": "CPT"}, {"code": "1000100", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.82, "maximum": 25.89, "gross_charge": 28.77, "discounted_cash": 54.17, "estimated_discounted_cash": 28.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM BICARB 4.2% 0.5 MEQ/ML INJ 5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "42000971", "type": "CDM"}, {"code": "63323002605", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM BICARB 8.4% 1MEQ/ML INJ 10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000428", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM BICARB 8.4% 1MEQ/ML INJ 50ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200157", "type": "CDM"}, {"code": "00409663724", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM BICARBONATE TAB 650MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000218", "type": "CDM"}, {"code": "00904726161", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM BLOOD", "code_information": [{"code": "84295", "type": "CPT"}, {"code": "1000201", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.53, "maximum": 25.62, "gross_charge": 28.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 22.77, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE .9% 50ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7050", "type": "HCPCS"}, {"code": "7200029", "type": "CDM"}, {"code": "00338004931", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.36, "maximum": 3.73, "gross_charge": 4.15, "discounted_cash": 54.17, "estimated_discounted_cash": 10.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 3.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 3.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.45% 1000ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7030", "type": "HCPCS"}, {"code": "7200014", "type": "CDM"}, {"code": "00264780200", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 7.61, "maximum": 12.02, "gross_charge": 13.36, "discounted_cash": 54.17, "estimated_discounted_cash": 19.22, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% 1000ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7030", "type": "HCPCS"}, {"code": "7200027", "type": "CDM"}, {"code": "00338004904", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.23, "maximum": 14.58, "gross_charge": 16.2, "discounted_cash": 54.17, "estimated_discounted_cash": 19.22, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% 100ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7030", "type": "HCPCS"}, {"code": "7200030", "type": "CDM"}, {"code": "00338004948", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.6, "maximum": 8.84, "gross_charge": 9.83, "discounted_cash": 54.17, "estimated_discounted_cash": 19.22, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% 250ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7050", "type": "HCPCS"}, {"code": "7200016", "type": "CDM"}, {"code": "00338004902", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.3, "maximum": 5.22, "gross_charge": 5.8, "discounted_cash": 54.17, "estimated_discounted_cash": 10.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 3.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% 500ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7040", "type": "HCPCS"}, {"code": "7200028", "type": "CDM"}, {"code": "00338004904", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.64, "maximum": 8.91, "gross_charge": 9.9, "discounted_cash": 54.17, "estimated_discounted_cash": 12.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 8.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% 50ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7040", "type": "HCPCS"}, {"code": "7200019", "type": "CDM"}, {"code": "00338004931", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "estimated_discounted_cash": 12.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% IRRIGATION 250 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3001292", "type": "CDM"}, {"code": "00409613822", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% IRRIGATION 500 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3000532", "type": "CDM"}, {"code": "00338004803", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 0.9% NEB 3ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200020", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 1GM TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002594", "type": "CDM"}, {"code": "77333084410", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 3% 500ML IV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7131", "type": "HCPCS"}, {"code": "72000807", "type": "CDM"}, {"code": "00338005403", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 1.85, "maximum": 2.92, "gross_charge": 3.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM FLUORIDE F-18", "code_information": [{"code": "A9580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SODIUM, URINE RANDOM", "code_information": [{"code": "84300", "type": "CPT"}, {"code": "1000468", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.82, "maximum": 25.89, "gross_charge": 28.77, "discounted_cash": 54.17, "estimated_discounted_cash": 28.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE GRAFT ADDL TOOTH", "code_information": [{"code": "D4278", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE GRAFT FIRSTTOOTH", "code_information": [{"code": "D4277", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [{"code": "501", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [{"code": "500", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "502", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SOLID ORGAN TRANSPL PKG", "code_information": [{"code": "S2152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOLU CORTEF 100MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1720", "type": "HCPCS"}, {"code": "7000431", "type": "CDM"}, {"code": "00009001103", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLU CORTEF 250MG INJ", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J1720", "type": "HCPCS"}, {"code": "7000432", "type": "CDM"}, {"code": "00009001305", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLU MEDROL 125 MG INJ", "drug_information": {"unit": 25.0, "type": "EA"}, "code_information": [{"code": "J2919", "type": "HCPCS"}, {"code": "7000430", "type": "CDM"}, {"code": "00009004726", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 17.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLU MEDROL 40 MG INJ", "drug_information": {"unit": 8.0, "type": "EA"}, "code_information": [{"code": "J2919", "type": "HCPCS"}, {"code": "7200080", "type": "CDM"}, {"code": "00009003932", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 17.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLU MEDROL 500 MG INJ", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J2919", "type": "HCPCS"}, {"code": "7000433", "type": "CDM"}, {"code": "00009075801", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.51, "maximum": 19.75, "gross_charge": 21.95, "discounted_cash": 54.17, "estimated_discounted_cash": 17.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOMA (CARISOPRODOL) TAB 350MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000081", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SOMATOSENSORY TESTING", "code_information": [{"code": "95925", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOMATOSENSORY TESTING", "code_information": [{"code": "95926", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOMATOSENSORY TESTING", "code_information": [{"code": "95927", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOMATOSENSORY TESTING", "code_information": [{"code": "95938", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOMATREM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2940", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOMATROPIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2941", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOOTHE & COOL SKIN CREAM", "code_information": [{"code": "3001265", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SORBENT CARTRIDGES PER 10", "code_information": [{"code": "E1636", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SORBITOL SOLUTION 70%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003836", "type": "CDM"}, {"code": "46287050001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SORBSAN DRESSING", "code_information": [{"code": "3000537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SOTALOL HYDROCHLORIDE IV", "code_information": [{"code": "C9482", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SP BONE AGRFT LOCAL ADD-ON", "code_information": [{"code": "20936", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SP BONE AGRFT MORSEL ADD-ON", "code_information": [{"code": "20937", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SP BONE AGRFT STRUCT ADD-ON", "code_information": [{"code": "20938", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SP BONE ALGRFT MORSEL ADD-ON", "code_information": [{"code": "20930", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SP BONE ALGRFT STRUCT ADD-ON", "code_information": [{"code": "20931", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPACE MAINTAINER FXD UNILAT", "code_information": [{"code": "D1510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPACER BAG/RESERVOIR", "code_information": [{"code": "A4627", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPACER WITH MASK", "code_information": [{"code": "S8101", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPACER WITHOUT MASK", "code_information": [{"code": "S8100", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC CHILDCARE WAIVER 15 MIN", "code_information": [{"code": "T2027", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC COLL NON-BLOOD:A/D TEST", "code_information": [{"code": "H0048", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC GENE TEST HYP CARDIOMY", "code_information": [{"code": "S3866", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC RPT NO DOC CLASS HISTO", "code_information": [{"code": "G9425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC SIT NOT PRIM TUMOR", "code_information": [{"code": "G8723", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC SITE NO CUTANEOUS", "code_information": [{"code": "G9430", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC SITE NO LUNG", "code_information": [{"code": "G9420", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC STAINS FOR MICROORGANIS", "code_information": [{"code": "D0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEC STAINS NOT FOR MICROORG", "code_information": [{"code": "D0477", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL CASTING MATERIAL", "code_information": [{"code": "A4590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL CHILDCARE WAIVER/D", "code_information": [{"code": "T2026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL MED EQUIP, NOSWAIVER", "code_information": [{"code": "T2029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99190", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99191", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99192", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION DOSIMETRY", "code_information": [{"code": "77331", "type": "CPT"}], "standard_charges": [{"minimum": 107.03, "maximum": 107.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 107.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION TREATMENT", "code_information": [{"code": "77470", "type": "CPT"}], "standard_charges": [{"minimum": 226.7, "maximum": 226.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 226.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL REPORTS OR FORMS", "code_information": [{"code": "99080", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAINS GROUP 1", "code_information": [{"code": "88312", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 119.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 119.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAINS GROUP 2", "code_information": [{"code": "88313", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 85.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 85.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL SUPPLIES PHYS/QHP", "code_information": [{"code": "99070", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL SUPPLY, NOS WAIVER", "code_information": [{"code": "T2028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL TELETX PORT PLAN", "code_information": [{"code": "77321", "type": "CPT"}], "standard_charges": [{"minimum": 153.02, "maximum": 153.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 153.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIALTY CARE TRANSPORT", "code_information": [{"code": "A0434", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIMEN CUP STOOL", "code_information": [{"code": "3000296", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPECIMEN FAT STAIN", "code_information": [{"code": "89125", "type": "CPT"}], "standard_charges": [{"minimum": 6.76, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIMEN HANDLING OFFICE-LAB", "code_information": [{"code": "99000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIMEN HANDLING PT-LAB", "code_information": [{"code": "99001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIMEN SITE NOT ESOPHAGUS", "code_information": [{"code": "G8797", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIMEN SITE NOT PROSTATE", "code_information": [{"code": "G8798", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIPAN COLL W/GRAD", "code_information": [{"code": "3001033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPECTINOMYCN DI-HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOM THRESH & RECOG", "code_information": [{"code": "211T", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY COMPLETE", "code_information": [{"code": "92556", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY THRESHOLD", "code_information": [{"code": "210T", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH EVALUATION COMPLEX", "code_information": [{"code": "70371", "type": "CPT"}], "standard_charges": [{"minimum": 134.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 134.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH LANGUAGE PATH SS", "code_information": [{"code": "G4034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH SCREENING", "code_information": [{"code": "V5362", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH SOUND LANG COMPREHEN", "code_information": [{"code": "92523", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "estimated_discounted_cash": 562.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 102.19, "count": "1 through 10", "median_amount": 102.19, "methodology": "percent of total billed charges", "10th_percentile": 102.19, "90th_percentile": 102.19}], "billing_class": "facility"}]}, {"description": "SPEECH THERAPY, IN THE HOME,", "code_information": [{"code": "S9128", "type": "HCPCS"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH THERAPY, RE-EVAL", "code_information": [{"code": "S9152", "type": "HCPCS"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH THRESHOLD AUDIOMETRY", "code_information": [{"code": "92555", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92507", "type": "CPT"}], "standard_charges": [{"minimum": 76.04, "maximum": 737.34, "discounted_cash": 54.17, "estimated_discounted_cash": 225.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 76.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 84.15, "count": "1 through 10", "median_amount": 127.53, "methodology": "percent of total billed charges", "10th_percentile": 19.08, "90th_percentile": 127.53}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92508", "type": "CPT"}], "standard_charges": [{"minimum": 23.26, "maximum": 23.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM ANTIBODY TEST", "code_information": [{"code": "89325", "type": "CPT"}], "standard_charges": [{"minimum": 12.27, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM EVALUATION TEST", "code_information": [{"code": "89329", "type": "CPT"}], "standard_charges": [{"minimum": 22.53, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM IDENTIFICATION", "code_information": [{"code": "89257", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 315.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 315.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION COMPLEX", "code_information": [{"code": "89261", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 90.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 90.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION SIMPLE", "code_information": [{"code": "89260", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 97.56, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 97.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM PROCURE INIT VISIT", "code_information": [{"code": "S4030", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM PROCURE SUBS VISIT", "code_information": [{"code": "S4031", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM WASHING", "code_information": [{"code": "58323", "type": "CPT"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERMICIDE", "code_information": [{"code": "A4269", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPHENOID SINUS SURGERY", "code_information": [{"code": "31051", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPHYG/BP APP W CUFF AND STET", "code_information": [{"code": "A4660", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95990", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95991", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPINAL DISK SURGERY ADD-ON", "code_information": [{"code": "63035", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITH CC/MCC", "code_information": [{"code": "52", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC", "code_information": [{"code": "53", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC", "code_information": [{"code": "457", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [{"code": "456", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC", "code_information": [{"code": "458", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPINAL ORTHOSIS NOS", "code_information": [{"code": "L1499", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [{"code": "29", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH MCC", "code_information": [{"code": "28", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "30", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPINE DEVICE IMPLANT SURGERY", "code_information": [{"code": "C9757", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63077", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63078", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIR RES DOC FEV1/FVC<70%", "code_information": [{"code": "G8924", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIRIVA (TIOTROPIUM BROM) INH 18MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000223", "type": "CDM"}, {"code": "00597007575", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 126.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPIRIVA RESP (NF-Spiriva Resp)Inh 2.5MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002762", "type": "CDM"}, {"code": "00597010051", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 114.18, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPIRMTRY W/BRNCHDIL INF-2 YR", "code_information": [{"code": "94012", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIRO RESULTS WTH OBS DOC", "code_information": [{"code": "M1214", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIROM DOC REV", "code_information": [{"code": "3023F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIROM FEV/FVC <70% W/COPD", "code_information": [{"code": "3025F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIROM FEV/FVC>=70%/W/OCOPD", "code_information": [{"code": "3027F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPIROMETRY INCENTIVE", "code_information": [{"code": "94010", "type": "CPT"}, {"code": "4200008", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 107.5, "maximum": 169.74, "gross_charge": 188.61, "discounted_cash": 54.17, "estimated_discounted_cash": 188.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 141.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 150.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 169.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 107.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIROMETRY UP TO 2 YRS OLD", "code_information": [{"code": "94011", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLASH GUARD SAF-SHIELD", "code_information": [{"code": "3001183", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLEEN IMAGING", "code_information": [{"code": "78185", "type": "CPT"}], "standard_charges": [{"minimum": 205.04, "maximum": 205.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 205.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH CC", "code_information": [{"code": "800", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH MCC", "code_information": [{"code": "799", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "801", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPLICE SPLEEN/KIDNEY VEINS", "code_information": [{"code": "37181", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLICING OF URETERS", "code_information": [{"code": "50770", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT", "code_information": [{"code": "A4570", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT ADLT PLAS TIB", "code_information": [{"code": "3000297", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT ADLT/PED META", "code_information": [{"code": "3000298", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT ANKLE CANVASE LG", "code_information": [{"code": "29540", "type": "CPT"}, {"code": "3000302", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"minimum": 35.51, "maximum": 138.66, "gross_charge": 62.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 49.84, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 56.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 35.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINT ANKLE CANVASE SM", "code_information": [{"code": "3000300", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 62.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT CLAVICLE LG", "code_information": [{"code": "3000304", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT CLAVICLE MED", "code_information": [{"code": "3000305", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT CLAVICLE STRAP SM", "code_information": [{"code": "3000306", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT DIGIT", "code_information": [{"code": "S8450", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT ELBOW", "code_information": [{"code": "S8452", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT EXTRA-CORONAL", "code_information": [{"code": "D4323", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT FINGER 4-PRONG MED", "code_information": [{"code": "3001251", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT FINGER ALUMINUM 1/2 X18", "code_information": [{"code": "3001260", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT FINGER ALUMINUM 3/4 X18", "code_information": [{"code": "3000307", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT INTRA-CORONAL", "code_information": [{"code": "D4322", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT MET THIGH LFT", "code_information": [{"code": "3000308", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT METAL FOREARM", "code_information": [{"code": "3000309", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT ORTHO-GLASS 2 X15' PER 1", "code_information": [{"code": "3001403", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT ORTHO-GLASS 3 X15' PER 1", "code_information": [{"code": "3001404", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT ORTHO-GLASS 4 x15' PER 1", "code_information": [{"code": "3001405", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT PLASTER FS 3X", "code_information": [{"code": "3000310", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT PREFAB (FOOT)", "code_information": [{"code": "3000311", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT SAM", "code_information": [{"code": "3000312", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 41.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT SUPPLIES MISC", "code_information": [{"code": "Q4051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT TENNIS ELBOW SUPPORT EXLG", "code_information": [{"code": "3000313", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT TENNIS ELBOW SUPPORT LG", "code_information": [{"code": "3000314", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT TENNIS ELBOW SUPPORT MD", "code_information": [{"code": "3000315", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT TENNIS ELBOW SUPPORT SM", "code_information": [{"code": "3000316", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 32.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT THUMB ALUM", "code_information": [{"code": "3000317", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT TIB/FIB 24 ADULT", "code_information": [{"code": "3000320", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT TIB/FIB CHLID 8", "code_information": [{"code": "3000322", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPLINT WRIST OR ANKLE", "code_information": [{"code": "S8451", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLIT BLOOD OR PRODUCTS", "code_information": [{"code": "86985", "type": "CPT"}], "standard_charges": [{"minimum": 26.5, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS STUDY", "code_information": [{"code": "92531", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS TEST", "code_information": [{"code": "92541", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPORANOX (ITRACONAZOLE) 100MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004300", "type": "CDM"}, {"code": "67877045430", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC", "code_information": [{"code": "537", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC", "code_information": [{"code": "538", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SPRCHOROIDAL SPC NJX RX AGT", "code_information": [{"code": "67516", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPROAM CLEANSER 12OZ", "code_information": [{"code": "3000335", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPRVSD XRCZ BACK PN >12 WKS", "code_information": [{"code": "4242F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPUN MICROHEMATOCRIT", "code_information": [{"code": "85013", "type": "CPT"}], "standard_charges": [{"minimum": 8.05, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPUTUM COLLECTION", "code_information": [{"code": "3000336", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SPUTUM CYTOLOGY", "code_information": [{"code": "88108", "type": "CPT"}, {"code": "1000134", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 30.71, "maximum": 88.42, "gross_charge": 98.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 68.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 78.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 88.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPUTUM SPECIMEN COLLECTION", "code_information": [{"code": "89220", "type": "CPT"}], "standard_charges": [{"minimum": 19.46, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SR89 STRONTIUM", "code_information": [{"code": "A9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRCH FOR CT W IN 12 MOS", "code_information": [{"code": "G9341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES COMPLEX ADDL", "code_information": [{"code": "61799", "type": "CPT"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES SIMPLE ADDL", "code_information": [{"code": "61797", "type": "CPT"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION COMPLEX", "code_information": [{"code": "61798", "type": "CPT"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION SIMPLE", "code_information": [{"code": "61796", "type": "CPT"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS LINEAR BASED", "code_information": [{"code": "77372", "type": "CPT"}], "standard_charges": [{"minimum": 1555.82, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1555.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS MULTISOURCE", "code_information": [{"code": "77371", "type": "CPT"}], "standard_charges": [{"minimum": 1765.19, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1765.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION", "code_information": [{"code": "63620", "type": "CPT"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION ADDL", "code_information": [{"code": "63621", "type": "CPT"}], "standard_charges": [{"minimum": 19013.95, "maximum": 19013.95, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 19013.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRSF2 GENE COMMON VARIANTS", "code_information": [{"code": "81348", "type": "CPT"}], "standard_charges": [{"minimum": 201.71, "maximum": 201.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ST ASSESMENT OF APHASIA", "code_information": [{"code": "4600002", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 268.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST BEHAVIOR ANALYSIS OF VOICE", "code_information": [{"code": "4600046", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 272.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST EVAL AUG & ALT COMM SP DEV 1 HR", "code_information": [{"code": "4600036", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 371.37, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST EVAL AUG & ALT COMM SP GEN EA ADD 30", "code_information": [{"code": "4600035", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 149.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST EVAL OF SPEECH FLUENCY", "code_information": [{"code": "4600043", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 324.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST EVAL SND PROD W/LANGUAGE", "code_information": [{"code": "4600045", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 562.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST EVAL SOUND PRODUCTION", "code_information": [{"code": "4600044", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 263.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST EVAL SPEECH FLUENCY", "code_information": [{"code": "4600048", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 324.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST NEUROMUS RE-EDUCATE", "code_information": [{"code": "4600015", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 99.09, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST SPEECH TREATMENT", "code_information": [{"code": "4600025", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 223.74, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST SPEECH/LANG/HEAT TX GROUP", "code_information": [{"code": "4600033", "type": "CDM"}, {"code": "443", "type": "RC"}], "standard_charges": [{"gross_charge": 65.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST STANDARD COGNITIVE TESTING", "code_information": [{"code": "4600047", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 336.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST SWALLOWING EVAL", "code_information": [{"code": "4600041", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 218.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST SWALLOWING TREATMENT", "code_information": [{"code": "4600026", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 244.29, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST THERAPEUTIC EXERCISE", "code_information": [{"code": "4600042", "type": "CDM"}, {"code": "421", "type": "RC"}], "standard_charges": [{"gross_charge": 89.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ST TX AUGMENT & ALT COMM SP GEN DEVICE", "code_information": [{"code": "4600029", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 311.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STAB PHLEB VEINS XTR 10-20", "code_information": [{"code": "37765", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STADOL (BUTORPHANOL) 2MG/ML INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0595", "type": "HCPCS"}, {"code": "72000250", "type": "CDM"}, {"code": "00409162601", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STADOL (BUTORPHANOL) 4MG/2ML INJ", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J0595", "type": "HCPCS"}, {"code": "72001103", "type": "CDM"}, {"code": "00409162602", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.97, "maximum": 18.9, "gross_charge": 21.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAGGERED SPONDAIC WORD TEST", "code_information": [{"code": "92572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STALEVO (CARBIDO,LEVODO,ENTACA) 75MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002154", "type": "CDM"}, {"code": "00781562501", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STANDING FRAME SYS", "code_information": [{"code": "E0638", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STAPH A DNA AMP PROBE", "code_information": [{"code": "87640", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STAPLE GUN ETHICON", "code_information": [{"code": "3000539", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.07, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STAPLE REMOVER SKIN", "code_information": [{"code": "3000540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STAPLER, STANDARD", "code_information": [{"code": "80001248", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STARLIX (NATEGLINIDE) TAB 120MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000331", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1106", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1111", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1116", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1126", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "START EOC DOC MED REC", "code_information": [{"code": "M1135", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STAT FEE (LAB)", "code_information": [{"code": "1000141", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STAT LAB", "code_information": [{"code": "S3600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STAT LAB HOME/NF", "code_information": [{"code": "S3601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STATIN MED PRES AT DISCH", "code_information": [{"code": "G8816", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STATIN THERAPY/CURRENTLY TKN", "code_information": [{"code": "4013F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STEM CELLS TOTAL COUNT", "code_information": [{"code": "86367", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 89.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENGER TEST PURE TONE", "code_information": [{"code": "92565", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENGER TEST SPEECH", "code_information": [{"code": "92577", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT NON-CORONARY PROPEL", "code_information": [{"code": "S1091", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT ANTE CAROTID", "code_information": [{"code": "37218", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT RETRO CAROTID", "code_information": [{"code": "37217", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT PLMT CTR DIALYSIS SEG", "code_information": [{"code": "36908", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT, COATED/COV W/DEL SYS", "code_information": [{"code": "C1874", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT, COATED/COV W/O DEL SY", "code_information": [{"code": "C1875", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT, NON-COA/NON-COV W/DEL", "code_information": [{"code": "C1876", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT, NON-COAT/COV W/O DEL", "code_information": [{"code": "C1877", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT, NON-COR, TEM W/DEL SY", "code_information": [{"code": "C2625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT, NON-COR, TEM W/O DEL", "code_information": [{"code": "C2617", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STEREOISOMER ANALYSIS", "code_information": [{"code": "80374", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STEREOSCOPIC X-RAY GUIDANCE", "code_information": [{"code": "G6002", "type": "HCPCS"}], "standard_charges": [{"minimum": 573.7, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC RADIATION TRMT", "code_information": [{"code": "77432", "type": "CPT"}], "standard_charges": [{"minimum": 719.25, "maximum": 1008.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 719.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERILE FEILD BARRIER TOWEL", "code_information": [{"code": "3000541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STERILE GAUZE > 48 SQ IN", "code_information": [{"code": "A6404", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERILE NEEDLE", "code_information": [{"code": "A4215", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERILE SALINE OR WATER", "code_information": [{"code": "A4218", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERILE, GLOVES PER PAIR", "code_information": [{"code": "A4930", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERISTRIP 1/2 X 4", "code_information": [{"code": "3000542", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.58, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STERISTRIP 1/4 X 3", "code_information": [{"code": "3000543", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STERNAL DEBRIDEMENT", "code_information": [{"code": "21627", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STIMULANTS SYNTHETIC", "code_information": [{"code": "80371", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STIMULATED IUI CASE RATE", "code_information": [{"code": "S4035", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STIMULATION OF SPINAL CORD", "code_information": [{"code": "63610", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STIMULATION PACING HEART", "code_information": [{"code": "93623", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STIOLTO (NF-Stiolto Resp) Inh 2.5-2.5MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002082", "type": "CDM"}, {"code": "00597015561", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 1549.71, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STOCKINETT 12 INCH", "code_information": [{"code": "3000337", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STOCKINETT 2 INCH", "code_information": [{"code": "3000338", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.82, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STOCKINETT 3 INCH", "code_information": [{"code": "3000339", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STOCKINETT 4 INCH BIAS-CUT", "code_information": [{"code": "3000340", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STOCKINETT 4 TUBULAR", "code_information": [{"code": "80000899", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STOCKINETT 6 INCH", "code_information": [{"code": "3000341", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STOCKINETT 8 INCH", "code_information": [{"code": "3000342", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [{"code": "327", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [{"code": "326", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "328", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "STOMAHESIVE WAFERS", "code_information": [{"code": "3000351", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STONE PROFILE ASSOCIATED CHARGES", "code_information": [{"code": "82436", "type": "CPT"}, {"code": "1000378", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.61, "maximum": 26.78, "gross_charge": 29.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STONE PROFILE ASSOCIATED CHARGES", "code_information": [{"code": "84300", "type": "CPT"}, {"code": "1000386", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.82, "maximum": 25.89, "gross_charge": 28.77, "discounted_cash": 54.17, "estimated_discounted_cash": 28.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOOL FOR WBC", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "1000073", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 4.91, "maximum": 23.08, "gross_charge": 25.26, "discounted_cash": 54.17, "estimated_discounted_cash": 25.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOOL LACTOFERRIN", "code_information": [{"code": "83631", "type": "CPT"}, {"code": "1000905", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 22.57, "maximum": 135.0, "gross_charge": 150.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOOL O&P", "code_information": [{"code": "87177", "type": "CPT"}, {"code": "1000105", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.24, "maximum": 47.41, "gross_charge": 52.68, "discounted_cash": 54.17, "estimated_discounted_cash": 52.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.14, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOOL YERSINIA", "code_information": [{"code": "87071", "type": "CPT"}, {"code": "1000323", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.37, "maximum": 47.25, "gross_charge": 52.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOP CONTROL NOSE BLEED POSTERIOR TECH", "code_information": [{"code": "30905", "type": "CPT"}, {"code": "11000211", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOP NOES BLEED COMPLEX TECH", "code_information": [{"code": "30903", "type": "CPT"}, {"code": "11000212", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOP NOSE BLEED SIMPLE TECH", "code_information": [{"code": "30901", "type": "CPT"}, {"code": "11000215", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 179.61, "maximum": 283.6, "gross_charge": 315.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 236.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 252.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 283.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 179.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOPCOCK 3-WAY W/MAL", "code_information": [{"code": "3000352", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STORAGE BOXES LETTER", "code_information": [{"code": "80000915", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STORAGE/YEAR EMBRYO(S)", "code_information": [{"code": "89342", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 195.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 195.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR OOCYTE(S)", "code_information": [{"code": "89346", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 273.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 273.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR REPROD TISSUE", "code_information": [{"code": "89344", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 80.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR SPERM/SEMEN", "code_information": [{"code": "89343", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 217.46, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 217.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STORE PREV FROZ EMBRYOS", "code_information": [{"code": "S4027", "type": "HCPCS"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STR MARKERS SPEC ANAL ADDL", "code_information": [{"code": "81266", "type": "CPT"}], "standard_charges": [{"minimum": 350.53, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 350.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STR MARKERS SPECIMEN ANAL", "code_information": [{"code": "81265", "type": "CPT"}], "standard_charges": [{"minimum": 268.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 268.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF CHEST", "code_information": [{"code": "29200", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF ELBOW OR WRIST", "code_information": [{"code": "29260", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HAND OR FINGER", "code_information": [{"code": "29280", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HIP", "code_information": [{"code": "29520", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF KNEE", "code_information": [{"code": "29530", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF SHOULDER", "code_information": [{"code": "29240", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF TOES", "code_information": [{"code": "29550", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRATTICE TM", "code_information": [{"code": "Q4130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREP A AG IA", "code_information": [{"code": "87430", "type": "CPT"}], "standard_charges": [{"minimum": 19.33, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREP A DNA AMP PROBE", "code_information": [{"code": "87651", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREP A DNA DIR PROBE", "code_information": [{"code": "87650", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREP A DNA QUANT", "code_information": [{"code": "87652", "type": "CPT"}], "standard_charges": [{"minimum": 48.02, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREP A TEST", "code_information": [{"code": "87880", "type": "CPT"}, {"code": "1000057", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 19.01, "maximum": 63.9, "gross_charge": 71.01, "discounted_cash": 54.17, "estimated_discounted_cash": 71.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 63.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B ASSAY W/OPTIC", "code_information": [{"code": "87802", "type": "CPT"}], "standard_charges": [{"minimum": 14.64, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREP B DNA AMP PROBE", "code_information": [{"code": "87653", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREPTOCOCCUS PNEUMONIAE ANTIGEN", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "1000544", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 18.48, "maximum": 103.5, "gross_charge": 115.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 65.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOKINASE ANTIBODY", "code_information": [{"code": "86590", "type": "CPT"}], "standard_charges": [{"minimum": 14.56, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREPTOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STREPTOZOCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9320", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.3, "maximum": 631.3, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRESS BREAKER", "code_information": [{"code": "D6940", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.81, "maximum": 328.81, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 328.81, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRESS MGMT CLASS", "code_information": [{"code": "S9454", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRESS TTE COMPLETE", "code_information": [{"code": "93351", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRESS TTE ONLY", "code_information": [{"code": "93350", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRESS W/ZINC (MULTIVIT/ZINC) TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000436", "type": "CDM"}, {"code": "80681011200", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STRIATIONAL ANTIBODIES", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "1000561", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.86, "maximum": 96.7, "gross_charge": 71.34, "discounted_cash": 54.17, "estimated_discounted_cash": 74.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 57.07, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 64.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 40.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRK CR PREV POS OUTCME MVP", "code_information": [{"code": "G0054", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STYLET ENDO 12 FR", "code_information": [{"code": "3001429", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STYLET ENDO 14 FR", "code_information": [{"code": "3001431", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STYLET ENDO 1O FR", "code_information": [{"code": "3001430", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STYLET ENDO 5 FR", "code_information": [{"code": "3001468", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STYLET ENDO 6 FR", "code_information": [{"code": "3001432", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STYLETTE LARGE (ADULT)", "code_information": [{"code": "3000354", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STYLETTE MEDIUM (CHILD)", "code_information": [{"code": "3000355", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "STYLETTE SMALL (NEONATAL)", "code_information": [{"code": "3000353", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUBCONJUNCTIVAL INJECTION", "code_information": [{"code": "68200", "type": "CPT"}, {"code": "68200001", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 91.82, "maximum": 232.11, "gross_charge": 161.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 120.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 128.88, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 144.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 91.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBRTA NJX RX AGT W/VTRC", "code_information": [{"code": "810T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBS EPISODE FOR CONDITION", "code_information": [{"code": "1128F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBS EVAL FOR CONDITION", "code_information": [{"code": "1121F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBS VISIT FOR EPISODE", "code_information": [{"code": "526F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBSEQUENT PRENATAL CARE", "code_information": [{"code": "502F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBSEQUENT REPAIR OF NERVE", "code_information": [{"code": "64872", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/DEB", "code_information": [{"code": "29906", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/EXC", "code_information": [{"code": "29905", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FB RMVL", "code_information": [{"code": "29904", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FUSION", "code_information": [{"code": "29907", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUBTEMPORAL DECOMPRESSION", "code_information": [{"code": "61340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUCCINYLCHOLINE 200MG/10ML INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J0330", "type": "HCPCS"}, {"code": "7000401", "type": "CDM"}, {"code": "00409662912", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.94, "maximum": 14.13, "gross_charge": 15.7, "discounted_cash": 54.17, "estimated_discounted_cash": 15.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCT. CATH 18FR", "code_information": [{"code": "3001182", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUCT. CATH 6FR", "code_information": [{"code": "3001181", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUCTION CANISTER 1200CC", "code_information": [{"code": "3000356", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 22.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUCTION CATH TRAY 14FR", "code_information": [{"code": "3000471", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.83, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY HEAD&NECK", "code_information": [{"code": "15876", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY LWR EXTREM", "code_information": [{"code": "15879", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY TRUNK", "code_information": [{"code": "15877", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY UPR EXTREM", "code_information": [{"code": "15878", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUCTION YANKAUER", "code_information": [{"code": "3000405", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 5.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUANT", "code_information": [{"code": "84379", "type": "CPT"}], "standard_charges": [{"minimum": 13.26, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUAL", "code_information": [{"code": "84376", "type": "CPT"}], "standard_charges": [{"minimum": 6.33, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUICD BASED CLN EVAL", "code_information": [{"code": "M1355", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUICD BASED CLN EVAL", "code_information": [{"code": "M1361", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUICD C-SSRS ASSESSMENT", "code_information": [{"code": "M1360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUICD C-SSRS ASSESSMENT, EQU", "code_information": [{"code": "M1352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUICIDE RISK ASSESSED", "code_information": [{"code": "3085F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SULAMYD (SULFACET) 10% OPTH SOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000438", "type": "CDM"}, {"code": "24208067004", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 93.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SULFAMYLON 5% TOP SOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001004", "type": "CDM"}, {"code": "51079062485", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SULINDAC TAB 150MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000612", "type": "CDM"}, {"code": "23155000501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUNGLASS FRAMES", "code_information": [{"code": "S0518", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUP FEE ANTIEM,ANTICA,IMMUNO", "code_information": [{"code": "Q0511", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPERIMPOSED PROSTHESIS", "code_information": [{"code": "D5954", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPERIOR MOBIL MEDICS INC.", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "1000940", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 18.0, "gross_charge": 20.0, "discounted_cash": 54.17, "estimated_discounted_cash": 11.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPLENA", "code_information": [{"code": "80001228", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUPP FOR SELF-ADM INJECTIONS", "code_information": [{"code": "A4211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPP MAINT EMPLOY, 15 MIN", "code_information": [{"code": "H2025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPP MAINT EMPLOY, PER DIEM", "code_information": [{"code": "H2026", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPLEMENTAL ELECTRICAL TEST", "code_information": [{"code": "92547", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPLIES FOR HOME DELIVERY", "code_information": [{"code": "S8415", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPLIES FOR ULTRA DIATHERM", "code_information": [{"code": "K1036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPLY, NOS", "code_information": [{"code": "T5999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPLY/ACCESSORY/SERVICE", "code_information": [{"code": "A9900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORT BROKER WAIVER/15 MIN", "code_information": [{"code": "T2041", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORT BROKER WAIVER/DIEM", "code_information": [{"code": "T2051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORT CARE NEUR COND MVP", "code_information": [{"code": "M0004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORT FOR ORGAN DONOR", "code_information": [{"code": "1990", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORTED EMPLOY, PER 15 MIN", "code_information": [{"code": "H2023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORTED EMPLOY, PER DIEM", "code_information": [{"code": "H2024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORTED HOUSING, PER DIEM", "code_information": [{"code": "H0043", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORTED HOUSING, PER MONTH", "code_information": [{"code": "H0044", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPRELIN LA IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9226", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPRA SDRM, PER SQ CM", "code_information": [{"code": "A2011", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPRATHEL, PER SQ CM", "code_information": [{"code": "A2012", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPRV INTERFAC TRNSPORT ADDL", "code_information": [{"code": "99486", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPRV INTERFACILTY TRANSPORT", "code_information": [{"code": "99485", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURFACE EMG", "code_information": [{"code": "S3900", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURFACTANT ADMIN THRU TUBE", "code_information": [{"code": "94610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURFACTOR /NUDYN PER 0.5 CC", "code_information": [{"code": "Q4233", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG DX EXAM ANORECTAL", "code_information": [{"code": "45990", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF ANTERIOR", "code_information": [{"code": "D3501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF MOLAR", "code_information": [{"code": "D3503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF PREMOLAR", "code_information": [{"code": "D3502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG PLACE CRANIOFACIAL IMPL", "code_information": [{"code": "D7993", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG PLACE ZYGOMATIC IMPL", "code_information": [{"code": "D7994", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG PROC W/SILICONE OIL", "code_information": [{"code": "G9756", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG PROC W/SILICONE OIL", "code_information": [{"code": "G9757", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG REDCT FIBROUS TUBEROSIT", "code_information": [{"code": "D7972", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG REDUCT OSSEOUSTUBEROSIT", "code_information": [{"code": "D7485", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG REMOVAL OF IMPLANT BODY", "code_information": [{"code": "D6100", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES ANTERIOR", "code_information": [{"code": "D3471", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES MOLAR", "code_information": [{"code": "D3473", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES PREMOLAR", "code_information": [{"code": "D3472", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY ELECTROCORTICOGRAM", "code_information": [{"code": "95829", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR LIVER LESION", "code_information": [{"code": "47300", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR URETHRA POUCH", "code_information": [{"code": "53240", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR VULVA LESION", "code_information": [{"code": "56440", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY OF GREAT VESSEL", "code_information": [{"code": "33916", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY OF PANCREATIC CYST", "code_information": [{"code": "48500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27475", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27477", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27479", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27485", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY/SPEECH PROSTHESIS", "code_information": [{"code": "31611", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL BOOT EACH CHILD", "code_information": [{"code": "L3209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL BOOT EACH INFANT", "code_information": [{"code": "L3208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL BOOT EACH JUNIOR", "code_information": [{"code": "L3211", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL EXPOSURE PROSTATE", "code_information": [{"code": "55860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL MASK", "code_information": [{"code": "A4928", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OBTURATOR", "code_information": [{"code": "D5931", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43351", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43352", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43510", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF THROAT", "code_information": [{"code": "42955", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH GROSS", "code_information": [{"code": "88300", "type": "CPT"}], "standard_charges": [{"minimum": 16.29, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL PLACE MINI IMPLANT", "code_information": [{"code": "D6013", "type": "HCPCS"}], "standard_charges": [{"minimum": 4165.24, "maximum": 4165.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4165.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43502", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL REVISION INTESTINE", "code_information": [{"code": "44680", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL REVISION PROCEDURE", "code_information": [{"code": "D4268", "type": "HCPCS"}], "standard_charges": [{"minimum": 3605.85, "maximum": 3605.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3605.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL SIALOLITHOTOMY", "code_information": [{"code": "D7980", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL SITE INFECTION", "code_information": [{"code": "G9312", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL SPLINT", "code_information": [{"code": "D5988", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL STENT", "code_information": [{"code": "D5982", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL SUPPLIES", "code_information": [{"code": "A4649", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL TRAYS", "code_information": [{"code": "A4550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICORD PER SQ CM", "code_information": [{"code": "Q4218", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGIGRAFT DUAL PER SQ CM", "code_information": [{"code": "Q4219", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGIGRAFT, 1 SQ CM", "code_information": [{"code": "Q4183", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGIMEND, FETAL", "code_information": [{"code": "C9358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGIMEND, NEONATAL", "code_information": [{"code": "C9360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGRAFT FT PER SQ CM", "code_information": [{"code": "Q4268", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGRAFT PER SQ CM", "code_information": [{"code": "Q4209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGRAFT TL, PER SQ CM", "code_information": [{"code": "Q4263", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGRAFT XT PER SQ CM", "code_information": [{"code": "Q4269", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURI-CUFF 5105", "code_information": [{"code": "80001101", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURV SCORE NO IMPROV W/TX", "code_information": [{"code": "G9605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURVEY NOT COMPLETE", "code_information": [{"code": "G0914", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPEND BOWEL W/PROSTHESIS", "code_information": [{"code": "44700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF BREAST", "code_information": [{"code": "19316", "type": "CPT"}], "standard_charges": [{"minimum": 10335.2, "maximum": 10335.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10335.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF TESTIS", "code_information": [{"code": "54620", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58410", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF VAGINA", "code_information": [{"code": "57280", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE 3-0 POLYPROPYLENE 18 BLUE", "code_information": [{"code": "3001280", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE 4-0 CHROMIC GUT", "code_information": [{"code": "3000559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE 5-0 CHROMIC GUT", "code_information": [{"code": "3001186", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 31.15, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE AND STAPLE REM BY NURSE", "code_information": [{"code": "99211", "type": "CPT"}, {"code": "11001260", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 51.65, "maximum": 81.56, "gross_charge": 90.63, "discounted_cash": 54.17, "estimated_discounted_cash": 155.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 72.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 81.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE BILE DUCT INJURY", "code_information": [{"code": "47900", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE COMPLICATE WND > 5 CM", "code_information": [{"code": "D7912", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 5-0 BLK PS-3", "code_information": [{"code": "3001283", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.62, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 5/O 18IN BLK PS-3P-11", "code_information": [{"code": "3001350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE LARGE INTESTINE", "code_information": [{"code": "44604", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE OR STAPLE REM BY NURSE", "code_information": [{"code": "99211", "type": "CPT"}, {"code": "11001258", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 51.65, "maximum": 81.56, "gross_charge": 90.63, "discounted_cash": 54.17, "estimated_discounted_cash": 155.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 72.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 81.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 51.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44602", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44603", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE-0 BLACK SILK", "code_information": [{"code": "3000544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-0 CHROMIC G-1", "code_information": [{"code": "3000545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-00 CHROMIC ETHICON 913M", "code_information": [{"code": "3000546", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-2-0 BLACK SILK", "code_information": [{"code": "3000547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.02, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-2-0 CHROMIC GUT", "code_information": [{"code": "3000548", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-2-0 ETHILON 664G", "code_information": [{"code": "3000549", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.07, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-2-0 VICRYL", "code_information": [{"code": "3000550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-3-0 BLACK SILK", "code_information": [{"code": "3000551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-3-0 CHROM GUT", "code_information": [{"code": "3000553", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.19, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-3-0 CHROMIC GUT 27", "code_information": [{"code": "3001045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-3-0 ETHILON 663G", "code_information": [{"code": "3000554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.22, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-3-0 PLN GUT G-322H", "code_information": [{"code": "3000555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-3-0 VICRYL", "code_information": [{"code": "3000556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-4-0 BLACK SILK", "code_information": [{"code": "3000557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-4-0 CHROMIC 793G", "code_information": [{"code": "3000558", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.92, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-4-0 ETHILON 6", "code_information": [{"code": "3000560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.23, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-4-0 VICRYL", "code_information": [{"code": "3000561", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.57, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-5-0 BLACK SILK", "code_information": [{"code": "3000562", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.27, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-5-0 ETHILON 661G", "code_information": [{"code": "3000564", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.11, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-5-0 VICRYL", "code_information": [{"code": "3000565", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-6-0 BLACK SILK", "code_information": [{"code": "3000566", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUTURE-6-0 ETHILON 660G", "code_information": [{"code": "3000567", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.57, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SV DOULA BRTH WRK PER 15 MIN", "code_information": [{"code": "T1032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SV DOULA BRTH WRK PER DIEM", "code_information": [{"code": "T1033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SVNT SARSCOV2 ELISA PLSM SRM", "code_information": [{"code": "226U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SVS BY OT IN HOME HEALTH", "code_information": [{"code": "G2169", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SVS BY PT IN HOME HEALTH", "code_information": [{"code": "G2168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SWAB CULTURETTE #2", "code_information": [{"code": "3000357", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SWABS MOUTH LEMON/GLYCERIN", "code_information": [{"code": "3000227", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SWEEM CREAM 2OZ", "code_information": [{"code": "3000358", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SWIVEL ADAPTOR", "code_information": [{"code": "S8186", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYFLS TST NONTREPONEMAL ANTB", "code_information": [{"code": "65U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMBICORT 160/4.5MG INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000500", "type": "CDM"}, {"code": "00310737020", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 700.17, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYMBICORT 80/4.5 INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000444", "type": "CDM"}, {"code": "00186037020", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYMMETREL (AMANTADINE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000312", "type": "CDM"}, {"code": "72888003330", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.63, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY CERVICAL", "code_information": [{"code": "64802", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY DIGITAL ARTERY", "code_information": [{"code": "64820", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY SUPFC PALMAR", "code_information": [{"code": "64823", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMPHONY, PER SQ CM", "code_information": [{"code": "A2009", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMPT SHOW CLIN IMPORT DROP", "code_information": [{"code": "1451F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMPT STEN-TIA/STRK<120DAYS", "code_information": [{"code": "9006F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMPTOM MGMNT PLAN CARE DOCD", "code_information": [{"code": "555F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMPTOM&SIGN SYMM POLYNEURO", "code_information": [{"code": "1500F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYMPTOMS IMPROVED/CONSIST", "code_information": [{"code": "1450F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYNCOPE AND COLLAPSE", "code_information": [{"code": "312", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "estimated_discounted_cash": 9055.29, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "SYNOJOYNT, INJ., 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7331", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYNTHETIC DRSG <= 16 SQ IN", "code_information": [{"code": "A6460", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYNTHETIC DRSG >16<=48 SQ IN", "code_information": [{"code": "A6461", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYNTHETIC GRAFT FACIAL BONES", "code_information": [{"code": "D7995", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYNTHETIC SENTENCE TEST", "code_information": [{"code": "92576", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYNTHROID (LEVOTHYROXINE) 100MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000445", "type": "CDM"}, {"code": "00904695361", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYNTHROID (LEVOTHYROXINE) 112MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000281", "type": "CDM"}, {"code": "00904695461", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYNTHROID (LEVOTHYROXINE) 137MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001031", "type": "CDM"}, {"code": "60687056301", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYNTHROID (LEVOTHYROXINE) 25MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000442", "type": "CDM"}, {"code": "60687045301", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYNTHROID (LEVOTHYROXINE) 50MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000443", "type": "CDM"}, {"code": "00904695061", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYNTHROID (LEVOTHYROXINE) 75MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000444", "type": "CDM"}, {"code": "00904695161", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYNTHROID (LEVOTHYROXINE) 88MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000200", "type": "CDM"}, {"code": "00904695261", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYNVISC OR SYNVISC-ONE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7325", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYPH SCRNG DOCD AS DONE", "code_information": [{"code": "3512F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYPHILIS TST ANTB IA QUAN", "code_information": [{"code": "210U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYRINGE W/NEEDLE INSULIN 3CC", "code_information": [{"code": "A4232", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYRINGE W/WO NEEDLE", "code_information": [{"code": "A4657", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYRN 12 CC LUERLOCK", "code_information": [{"code": "3000568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYRN 3 CC INTERLINK W/CANNULA", "code_information": [{"code": "3000576", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYRN 3 CC INTERLINK W/VIAL", "code_information": [{"code": "3000577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYRN 6 CC LUERLOCK", "code_information": [{"code": "3000579", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYRN 60 CC LUER LOCK TIP", "code_information": [{"code": "3001354", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.69, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYRN BULB IRRIG", "code_information": [{"code": "3000359", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYRN EAR", "code_information": [{"code": "3000360", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.56, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SYS BP > OR = 140", "code_information": [{"code": "G8753", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYS BP LESS 140", "code_information": [{"code": "G8752", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYS RSN NO DOC SPIRO", "code_information": [{"code": "M1217", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYS RSN NO PRESC BRONCHDIL", "code_information": [{"code": "G9698", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYS<140 AND DIA<90", "code_information": [{"code": "G9273", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYSRSN NO DICOM SRCH", "code_information": [{"code": "G9344", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYST ANTIMICROBIAL THX RX", "code_information": [{"code": "4131F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYST BP >= 140 MM HG", "code_information": [{"code": "3077F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYST BP GE 130 - 139MM HG", "code_information": [{"code": "3075F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYST BP LT 130 MM HG", "code_information": [{"code": "3074F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYST CORTICOSTEROIDS NOT RX", "code_information": [{"code": "4136F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYSTEMIC ANTIMICRO NOT PRESC", "code_information": [{"code": "G9959", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYSTEMIC ANTIMICRO PRESC", "code_information": [{"code": "G9961", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYSTEMIC CORTICOSTEROIDS RX", "code_information": [{"code": "4135F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYSTEMIC LUPUS ERYTHEMATOSUS PROFILE A", "code_information": [{"code": "86225", "type": "CPT"}, {"code": "1000967", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.8, "maximum": 73.19, "gross_charge": 81.33, "discounted_cash": 54.17, "estimated_discounted_cash": 92.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 65.06, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 73.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suici", "code_information": [{"code": "G0560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SanoGraft, per square centimeter", "code_information": [{"code": "Q4319", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sanopellis, per sq cm", "code_information": [{"code": "Q4308", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps and interface, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customize", "code_information": [{"code": "L1006", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia (ie, general anesthesia, moderate sedation), including patient monitoring, scalp, neck, hands, feet, and/or multiple digits; each additional 100 sq ", "code_information": [{"code": "976T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia (ie, general anesthesia, moderate sedation), including patient monitoring, scalp, neck, hands, feet, and/or multiple digits; first 100 sq cm", "code_information": [{"code": "975T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia (ie, general anesthesia, moderate sedation), including patient monitoring, trunk, arms, legs; each additional 100 sq cm (List separately in addition", "code_information": [{"code": "974T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Selective enzymatic debridement, partial-thickness and/or full-thickness burn eschar, requiring anesthesia (ie, general anesthesia, moderate sedation), including patient monitoring, trunk, arms, legs; first 100 sq cm", "code_information": [{"code": "973T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sentry SL matrix, per square centimeter", "code_information": [{"code": "Q4348", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0601", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0603", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 10 mcg/0.2 mL dosage, for intramuscular use", "code_information": [{"code": "91323", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Shelter DM matrix, per square centimeter", "code_information": [{"code": "Q4346", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Shortwave infrared radiation imaging, surgical pathology specimen, to assist gross examination for lymph node localization in fibroadipose tissue, per specimen (List separately in addition to code for primary procedure)", "code_information": [{"code": "961T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sigmoidoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed", "code_information": [{"code": "886T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SimpliGraft, per square centimeter", "code_information": [{"code": "Q4340", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SimpliMax, per square centimeter", "code_information": [{"code": "Q4341", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Simulation angiogram with use of a pressure-generating catheter (e.g., one-way valve, intermittently occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the angi", "code_information": [{"code": "C8004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Singlay, per square centimeter", "code_information": [{"code": "Q4329", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Stages I-III breast cancer", "code_information": [{"code": "M1394", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Stages I-III breast cancer", "code_information": [{"code": "M1401", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories", "code_information": [{"code": "E1832", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions", "code_information": [{"code": "G0563", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Streptococcus pneumoniae antibody (IgG), serotypes, multiplex immunoassay, quantitative", "code_information": [{"code": "86581", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Submucosal cryolysis therapy; base of tongue and lingual tonsil only", "code_information": [{"code": "980T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Submucosal cryolysis therapy; soft palate only", "code_information": [{"code": "979T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Submucosal cryolysis therapy; soft palate, base of tongue, and lingual tonsil", "code_information": [{"code": "978T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sucroferric oxyhydroxide, oral, 5 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0605", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Supplies and accessories for external tibial nerve stimulator (e.g., socks, gel pads, electrodes, etc.), needed for one month", "code_information": [{"code": "A4545", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Supplies and accessories for lung expansion airway clearance, continuous high frequency oscillation, and nebulization device (e.g., handset, nebulizer kit, biofilter)", "code_information": [{"code": "A7021", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month", "code_information": [{"code": "A4543", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan", "code_information": [{"code": "G0552", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Support device, extravascular, for arteriovenous fistula (implantable)", "code_information": [{"code": "C8000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Surgical care MIPS value pathway", "code_information": [{"code": "M1425", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the ", "code_information": [{"code": "98011", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the d", "code_information": [{"code": "98009", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on ", "code_information": [{"code": "98010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total t", "code_information": [{"code": "98008", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total tim", "code_information": [{"code": "98015", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time", "code_information": [{"code": "98013", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total", "code_information": [{"code": "98014", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When usin", "code_information": [{"code": "98012", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60", "code_information": [{"code": "98003", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 ", "code_information": [{"code": "98001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection", "code_information": [{"code": "98002", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code se", "code_information": [{"code": "98000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code sele", "code_information": [{"code": "98007", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selec", "code_information": [{"code": "98005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code ", "code_information": [{"code": "98006", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter fo", "code_information": [{"code": "98004", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "T PALLID IgG", "code_information": [{"code": "86593", "type": "CPT"}, {"code": "1000795", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.06, "maximum": 33.38, "gross_charge": 24.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T PALLID IgM", "code_information": [{"code": "86593", "type": "CPT"}, {"code": "1000794", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.06, "maximum": 33.38, "gross_charge": 24.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T-CELL DEPLETION OF HARVEST", "code_information": [{"code": "38210", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "T-LYMPHOCYTE HELPER/SUPPRESSOR PROFILE", "code_information": [{"code": "86359", "type": "CPT"}, {"code": "1000277", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 43.39, "maximum": 200.96, "gross_charge": 223.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 178.63, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 200.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 127.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T/PAD TEMPERATURE THERAPY", "code_information": [{"code": "3001027", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 14.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "T3 FREE", "code_information": [{"code": "84481", "type": "CPT"}, {"code": "1000204", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.48, "maximum": 84.78, "gross_charge": 94.2, "discounted_cash": 54.17, "estimated_discounted_cash": 90.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 75.36, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 84.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 53.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T3 TOTAL", "code_information": [{"code": "84480", "type": "CPT"}, {"code": "1000311", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.31, "maximum": 75.51, "gross_charge": 83.91, "discounted_cash": 54.17, "estimated_discounted_cash": 89.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 67.12, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 47.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T3 UPTAKE", "code_information": [{"code": "84479", "type": "CPT"}, {"code": "1000203", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.44, "maximum": 40.24, "gross_charge": 38.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 34.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T4", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "1000206", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.9, "maximum": 40.24, "gross_charge": 40.68, "discounted_cash": 54.17, "estimated_discounted_cash": 40.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T4 FREE", "code_information": [{"code": "84439", "type": "CPT"}, {"code": "1000173", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.37, "maximum": 48.06, "gross_charge": 53.4, "discounted_cash": 54.17, "estimated_discounted_cash": 53.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 48.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T4 FREE BY DIALYSIS / MASS SPEC", "code_information": [{"code": "84439", "type": "CPT"}, {"code": "1000174", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.37, "maximum": 48.06, "gross_charge": 53.4, "discounted_cash": 54.17, "estimated_discounted_cash": 53.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 42.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 48.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 30.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TA MV RPR W/ARTIF CHORD TEND", "code_information": [{"code": "543T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TABLE COVER WHITE (54X108)", "code_information": [{"code": "80000912", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TABLO FOR DIALYSIS SERVICE", "code_information": [{"code": "E1629", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TACRINE HYDROCHLORIDE, 10 MG", "code_information": [{"code": "S0014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TACROL ASTAGRAF EX REL ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TACROL ENVARSUS EX REL ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TACTILE BREAST IMG UNI/BI", "code_information": [{"code": "422T", "type": "CPT"}], "standard_charges": [{"minimum": 161.54, "maximum": 161.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAG, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4261", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAGAMET (CIMETIDINE) 300MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004301", "type": "CDM"}, {"code": "00093819201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAH RAD DEBULK/LYMPH REMOVE", "code_information": [{"code": "58954", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAH RAD DISSECT FOR DEBULK", "code_information": [{"code": "58953", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAKE HOME SUPPLY 8MG PER 0.1", "code_information": [{"code": "G1028", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAKE-HOM BUPRENORPHINE", "code_information": [{"code": "G2079", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAKE-HOME METH", "code_information": [{"code": "G2078", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAKING STATIN OR REC'D ORDER", "code_information": [{"code": "G9664", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TALK PT/CRGVR RE AREDS PREV", "code_information": [{"code": "4177F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TALK RE UV LIGHT PT/CRGVR", "code_information": [{"code": "4176F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TALYMED", "code_information": [{"code": "Q4127", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAMBOCOR (FLECAINIDE ACETATE) 100MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001119", "type": "CDM"}, {"code": "50268032115", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAMBOCOR (FLECAINIDE) 50MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002894", "type": "CDM"}, {"code": "50268032015", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAMIFLU (OSELTAMIVIR) CAP 75MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000446", "type": "CDM"}, {"code": "62332041510", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 21.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAMIFLU LIQ 6MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000335", "type": "CDM"}, {"code": "00004082205", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAMOXIFEN 10 MG", "code_information": [{"code": "S0187", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAMOXIFEN/AI PRESCRIBED", "code_information": [{"code": "4179F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "11103", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN SINGLE LES", "code_information": [{"code": "11102", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TANTALUM RING APPLICATION", "code_information": [{"code": "S8030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI BY INFUSION", "code_information": [{"code": "64489", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI INJECTION", "code_information": [{"code": "64488", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNI BY INFUSION", "code_information": [{"code": "64487", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNIL BY INJECTION", "code_information": [{"code": "64486", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAPAZOLE (METHIMAZOLE) 10MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000814", "type": "CDM"}, {"code": "60687068001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPAZOLE (METHIMAZOLE) 5MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000687", "type": "CDM"}, {"code": "23155007001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE ADHESIVE 2", "code_information": [{"code": "3000362", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 6.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE CLOTH SILK 1", "code_information": [{"code": "3000363", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE CLOTH SILK 2", "code_information": [{"code": "3000364", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE DISPENSER", "code_information": [{"code": "80001249", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.99, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE ELASTIKON ADHES 1", "code_information": [{"code": "80000913", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE ELASTIKON ADHES 2", "code_information": [{"code": "80000914", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE MEASURE", "code_information": [{"code": "80000482", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE MEDIPORE SOFT CLOTH SURG 4", "code_information": [{"code": "3001204", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.7, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE MEFIX 2 1 R", "code_information": [{"code": "3000239", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAPE, RETENTION, DRESSING, MEDFIX 4X11", "code_information": [{"code": "80001186", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TARGETED CASE MANAGEMENT", "code_information": [{"code": "T1017", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TARGETED CASE MGMT PER MONTH", "code_information": [{"code": "T2023", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TARKA (TRANDOLAPRIL/VERAP) TAB 2/180MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000390", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TARKA (TRANDOLAPRIL/VERAP) TAB 2/240MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000310", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TARKA (TRANDOLAPRIL/VERAP) TAB 4/240MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000211", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TAS CONGENITAL CAR ANOMAL", "code_information": [{"code": "33741", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TB AG RESPONSE T-CELL SUSP", "code_information": [{"code": "86481", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 115.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 115.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TB SCR 12 MO PRI FST BIO DZ", "code_information": [{"code": "M1003", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TB SCR NO PERF", "code_information": [{"code": "M1005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TB SCR PFRMD&INTERPD 6 MO", "code_information": [{"code": "3455F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TB SKIN TEST ONLY", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "10000012", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 10.97, "maximum": 47.16, "gross_charge": 52.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBP GENE DETC ABNOR ALLELES", "code_information": [{"code": "81344", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGG", "code_information": [{"code": "44U", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGM", "code_information": [{"code": "43U", "type": "CPT"}], "standard_charges": [{"minimum": 96.7, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TBS DXA CAL W/I&R FX RISK", "code_information": [{"code": "77089", "type": "CPT"}], "standard_charges": [{"minimum": 50.88, "maximum": 50.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TBS I&R FX RSK QHP", "code_information": [{"code": "77092", "type": "CPT"}], "standard_charges": [{"minimum": 13.51, "maximum": 13.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TBS TECHL CALCULATION ONLY", "code_information": [{"code": "77091", "type": "CPT"}], "standard_charges": [{"minimum": 34.45, "maximum": 34.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TBS TECHL PREP&TRANSMIS DATA", "code_information": [{"code": "77090", "type": "CPT"}], "standard_charges": [{"minimum": 2.92, "maximum": 2.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC AURICULR NEUROSTIMULATION", "code_information": [{"code": "783T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC MAG STIMJ PN 1ST NERVE", "code_information": [{"code": "766T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC MAG STIMJ PN EA ADDL NRV", "code_information": [{"code": "767T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC MEAS 5 BMRK SFDI M-S ALYS", "code_information": [{"code": "61U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC VIS LIT HYPERSPECTRAL IMG", "code_information": [{"code": "631T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99 TILMANOCEPT DIAG 0.5MCI", "code_information": [{"code": "A9520", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M APCITIDE", "code_information": [{"code": "A9504", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M BICISATE", "code_information": [{"code": "A9557", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M DEPREOTIDE", "code_information": [{"code": "A9536", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M DISOFENIN", "code_information": [{"code": "A9510", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M EXAMETAZIME", "code_information": [{"code": "A9521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M FANOLESOMAB", "code_information": [{"code": "A9566", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M GLUCEPTATE", "code_information": [{"code": "A9550", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M LABELED RBC", "code_information": [{"code": "A9560", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M MAA", "code_information": [{"code": "A9540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M MEBROFENIN", "code_information": [{"code": "A9537", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M MEDRONATE", "code_information": [{"code": "A9503", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M MERTIATIDE", "code_information": [{"code": "A9562", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M OXIDRONATE", "code_information": [{"code": "A9561", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M PENTETATE", "code_information": [{"code": "A9539", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M PERTECHNETATE", "code_information": [{"code": "A9512", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M PYROPHOSPHATE", "code_information": [{"code": "A9538", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M SESTAMIBI", "code_information": [{"code": "A9500", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M SUCCIMER", "code_information": [{"code": "A9551", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M SULFUR COLLOID", "code_information": [{"code": "A9541", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M TETROFOSMIN", "code_information": [{"code": "A9502", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT DLVR ENHNCD FIXJ DEV", "code_information": [{"code": "34712", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "33289", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT IMPLTJ C SINS RDCTJ DEV", "code_information": [{"code": "645T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INS 1CHMBR LDLS PM RA", "code_information": [{"code": "823T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM CMPL", "code_information": [{"code": "795T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RA", "code_information": [{"code": "796T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RV", "code_information": [{"code": "797T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INSJ/RPL PERM LDLS PM", "code_information": [{"code": "33274", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT INTRA-C NFS SUPERSAT O2", "code_information": [{"code": "659T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT MV ANNULUS RCNSTJ", "code_information": [{"code": "544T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT PLMT&RMVL CEPD PERQ", "code_information": [{"code": "33370", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 1CHMBR LDLS PM RA", "code_information": [{"code": "824T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 2CHMBR LDLS PM CMPL", "code_information": [{"code": "798T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL 2CHMBR LDLS PM", "code_information": [{"code": "801T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL1CHMB LDLS PM RA", "code_information": [{"code": "825T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RA", "code_information": [{"code": "802T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RV", "code_information": [{"code": "803T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RA", "code_information": [{"code": "799T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RV", "code_information": [{"code": "800T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL PERM LDLS PM W/IMG", "code_information": [{"code": "33275", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL/DBLK ICAR MAS PERQ", "code_information": [{"code": "644T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL OPN", "code_information": [{"code": "806T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL PRQ", "code_information": [{"code": "805T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT TV ANNULUS RCNSTJ", "code_information": [{"code": "545T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/INJ", "code_information": [{"code": "93893", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/O INJ", "code_information": [{"code": "93892", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCRAN MAGN STIM REDETEMINE", "code_information": [{"code": "90869", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX DELI", "code_information": [{"code": "90868", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX PLAN", "code_information": [{"code": "90867", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TDD", "code_information": [{"code": "V5272", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY HC PRO", "code_information": [{"code": "99368", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY PHYS", "code_information": [{"code": "99367", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/PAT BY HC PROF", "code_information": [{"code": "99366", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEAM EVALUATION & MANAGEMENT", "code_information": [{"code": "T1024", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEAR FILM IMG UNI/BI W/I&R", "code_information": [{"code": "330T", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TECH OTHER THAN SURFC CULTR", "code_information": [{"code": "4261F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC-99M AEROSOL", "code_information": [{"code": "A9567", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC-99M AUTO WBC", "code_information": [{"code": "A9569", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC-99M TEBOROXIME", "code_information": [{"code": "A9501", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC99M ARCITUMOMAB", "code_information": [{"code": "A9568", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TED HOSE KNEE HIGH LG/LONG", "code_information": [{"code": "3000343", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE KNEE HIGH LG/REG", "code_information": [{"code": "3001131", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 11.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE KNEE HIGH MED/LONG", "code_information": [{"code": "3001215", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 19.56, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE KNEE HIGH MED/REG", "code_information": [{"code": "3000344", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.63, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE KNEE HIGH SM/REG", "code_information": [{"code": "3000346", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE KNEE HIGH XL/LONG", "code_information": [{"code": "3001135", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE KNEE HIGH XL/REG", "code_information": [{"code": "3001136", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 11.49, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE KNEE HIGH XXL/LONG", "code_information": [{"code": "3001232", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.04, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH LG/LONG", "code_information": [{"code": "3000347", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 17.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH LG/REG", "code_information": [{"code": "3000349", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 25.9, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH MED/LONG", "code_information": [{"code": "3001214", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.53, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH MED/REG", "code_information": [{"code": "3000348", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 21.78, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH MED/SHORT", "code_information": [{"code": "3001130", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH SM/REG", "code_information": [{"code": "3001211", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.51, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH SM/SHORT", "code_information": [{"code": "3000350", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 23.53, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH XL/REG", "code_information": [{"code": "3001216", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 29.31, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TED HOSE THIGH HIGH XXL/LONG", "code_information": [{"code": "3001391", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 52.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT, MON", "code_information": [{"code": "C8927", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT,CONG", "code_information": [{"code": "C8926", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEFLARO (CEFTAROLINE) 600MG/ 100ML NS", "drug_information": {"unit": 60.0, "type": "EA"}, "code_information": [{"code": "J0712", "type": "HCPCS"}, {"code": "72001003", "type": "CDM"}, {"code": "00456060010", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 151.62, "maximum": 1601.71, "gross_charge": 266.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 239.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 151.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEGADERM 2 3/8 X 2 3/4", "code_information": [{"code": "3001460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEGADERM 4 X 4 3/4", "code_information": [{"code": "3000586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEGADERM DRSG 1 3/4 X 1 3/4", "code_information": [{"code": "3000583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEGADERM DRSG TRANSPARENT 6X8", "code_information": [{"code": "3000585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.33, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEGRETOL (CARBAMAZEPINE) TAB 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000078", "type": "CDM"}, {"code": "75834022101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEGRETOL LEVEL", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "1000049", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.76, "maximum": 77.57, "gross_charge": 86.19, "discounted_cash": 54.17, "estimated_discounted_cash": 86.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.95, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEKTURNA (aliskiren hemfum) TAB 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000609", "type": "CDM"}, {"code": "54868604200", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TELAVANCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3095", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEDENTISTRY DENT REVIEW", "code_information": [{"code": "D9996", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEDENTISTRY REAL-TIME", "code_information": [{"code": "D9995", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH FACILITY FEE", "code_information": [{"code": "Q3014", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.13, "maximum": 26.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH INPT PHARM MGMT", "code_information": [{"code": "G0459", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH TRANSMIT, PER MIN", "code_information": [{"code": "T1014", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEMONITORING/HOME PER MNTH", "code_information": [{"code": "S9110", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELESCOP/OTHR COMPOUND LENS", "code_information": [{"code": "V2615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELESCOPIC INTRAOCULAR LENS", "code_information": [{"code": "C1840", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN CPLX", "code_information": [{"code": "77307", "type": "CPT"}], "standard_charges": [{"minimum": 464.73, "maximum": 464.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 464.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77306", "type": "CPT"}], "standard_charges": [{"minimum": 238.44, "maximum": 238.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 238.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELFA PAD 2X3 STERILE", "code_information": [{"code": "3001133", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TELFA PAD 3 X 4", "code_information": [{"code": "3000588", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TELFA PAD 8 X 3", "code_information": [{"code": "3001392", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEMOZOLOMIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8700", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.48, "maximum": 438.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 438.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMOZOLOMIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9328", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMP ANCHORAGE DEV W FLAP", "code_information": [{"code": "D7293", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMP ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7294", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VALVE-PMP RPLCMT", "code_information": [{"code": "597T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VLV-PMP 1ST INSJ", "code_information": [{"code": "596T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMP OBTURATOR PROSTHESIS", "code_information": [{"code": "D5936", "type": "HCPCS"}], "standard_charges": [{"minimum": 966.79, "maximum": 966.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMPERATURE GRADIENT STUDIES", "code_information": [{"code": "93740", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMPORAL ARTERY PROCEDURE", "code_information": [{"code": "37609", "type": "CPT"}], "standard_charges": [{"minimum": 1422.05, "maximum": 1422.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1422.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMPORARY REPLACEMENT EQPMNT", "code_information": [{"code": "K0462", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMPORARY TEAR DUCT PLUG", "code_information": [{"code": "A4262", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMPOROMANDIBULAR JOINT DYSF", "code_information": [{"code": "D9130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMPR", "code_information": [{"code": "278T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEMSIROLIMUS INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9330", "type": "HCPCS"}], "standard_charges": [{"minimum": 2882.43, "maximum": 2882.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2882.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENDON EXCISION PALM/FINGER", "code_information": [{"code": "26145", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENDON LENGTHENING", "code_information": [{"code": "26476", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENDON LNGTH UPR A/E EA TDN", "code_information": [{"code": "24305", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENDON SHORTENING", "code_information": [{"code": "26477", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENDON TRANSFER WITH GRAFT", "code_information": [{"code": "26492", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [{"code": "557", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [{"code": "558", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TENIPOSIDE, 50 MG", "code_information": [{"code": "Q2017", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENODESIS BICEPS TDN AT ELBW", "code_information": [{"code": "24340", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR LIQ CHROM UR QUAN", "code_information": [{"code": "25U", "type": "CPT"}], "standard_charges": [{"minimum": 33.57, "maximum": 33.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENOGLIDE TENDON PROT, CM2", "code_information": [{"code": "C9356", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS TRICEPS", "code_information": [{"code": "24332", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENOPLASTY ELBOW TO SHO 1", "code_information": [{"code": "24320", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENORETIC (ATENOLOL/CHLOR) 50MG-25MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004173", "type": "CDM"}, {"code": "70710116701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TENORMIN (ATENOLOL) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000047", "type": "CDM"}, {"code": "00904718761", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TENORMIN (ATENOLOL) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000139", "type": "CDM"}, {"code": "51079068420", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TENORMIN (NF-TENORMIN) 100MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002555", "type": "CDM"}, {"code": "65862017099", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TENSION RING, VAC ERECT DEV", "code_information": [{"code": "L7902", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENSIX, 1CM", "code_information": [{"code": "Q4146", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE SULF COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7680", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE SULF COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7681", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TERIPARATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3110", "type": "HCPCS"}], "standard_charges": [{"minimum": 7308.2, "maximum": 7308.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7308.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TERT GENE TARGETED SEQ ALYS", "code_information": [{"code": "81345", "type": "CPT"}], "standard_charges": [{"minimum": 212.98, "maximum": 212.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TESSALON PERLE (BENZONATATE) CAP 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000171", "type": "CDM"}, {"code": "00904715361", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEST FECES FOR TRYPSIN", "code_information": [{"code": "84488", "type": "CPT"}], "standard_charges": [{"minimum": 8.4, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST FOR ACETONE/KETONES", "code_information": [{"code": "82009", "type": "CPT"}], "standard_charges": [{"minimum": 5.2, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST FOR BLOOD FLOW IN GRAFT", "code_information": [{"code": "15860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST FOR CHLOROHYDROCARBONS", "code_information": [{"code": "82441", "type": "CPT"}], "standard_charges": [{"minimum": 6.91, "maximum": 35.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST FOR G6PD ENZYME", "code_information": [{"code": "82960", "type": "CPT"}], "standard_charges": [{"minimum": 6.96, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST FOR PORPHOBILINOGEN", "code_information": [{"code": "84106", "type": "CPT"}], "standard_charges": [{"minimum": 6.69, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST FOR URINE CYSTINES", "code_information": [{"code": "82615", "type": "CPT"}], "standard_charges": [{"minimum": 10.98, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST RBC PROTOPORPHYRIN", "code_information": [{"code": "84203", "type": "CPT"}], "standard_charges": [{"minimum": 11.2, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST STRIPS PLATINUM", "code_information": [{"code": "80000855", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TEST URINE FOR LACTOSE", "code_information": [{"code": "83633", "type": "CPT"}], "standard_charges": [{"minimum": 12.94, "maximum": 15.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST URINE FOR PORPHYRINS", "code_information": [{"code": "84119", "type": "CPT"}], "standard_charges": [{"minimum": 15.36, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEST URINE UROBILINOGEN", "code_information": [{"code": "84578", "type": "CPT"}], "standard_charges": [{"minimum": 5.14, "maximum": 5.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITH CC/MCC", "code_information": [{"code": "711", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "712", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TESTICULAR IMAGING W/FLOW", "code_information": [{"code": "78761", "type": "CPT"}], "standard_charges": [{"minimum": 254.0, "maximum": 254.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 254.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE BIOAVAILABLE", "code_information": [{"code": "84410", "type": "CPT"}], "standard_charges": [{"minimum": 58.97, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE FREE & TOTAL SERUM", "code_information": [{"code": "84402", "type": "CPT"}, {"code": "1000001", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 29.29, "maximum": 135.64, "gross_charge": 150.72, "discounted_cash": 54.17, "estimated_discounted_cash": 150.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 120.57, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 135.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 85.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE RESPONSE PANEL", "code_information": [{"code": "80414", "type": "CPT"}], "standard_charges": [{"minimum": 59.39, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE TOTAL SERUM", "code_information": [{"code": "84403", "type": "CPT"}, {"code": "1000205", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 29.68, "maximum": 137.53, "gross_charge": 152.82, "discounted_cash": 54.17, "estimated_discounted_cash": 152.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 122.25, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 137.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 87.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE UNDECANOATE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3145", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TETANUS ANTIBODY", "code_information": [{"code": "86774", "type": "CPT"}], "standard_charges": [{"minimum": 17.02, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TETANUS DIP TOXOID ADULT 0.5ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "90714", "type": "CPT"}, {"code": "7000137", "type": "CDM"}, {"code": "49281021515", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 21.91, "maximum": 86.4, "gross_charge": 38.45, "discounted_cash": 54.17, "estimated_discounted_cash": 38.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 30.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 34.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETANUS IG IM", "code_information": [{"code": "90389", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TETANUS IMMUNE GLOBULIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1670", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TETANUS TOX ADSORBED 0.5ML IM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "90716", "type": "CPT"}, {"code": "7000453", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 197.44, "maximum": 350.17, "gross_charge": 346.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 259.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 277.12, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 311.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 197.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETRACAINE OPTH DROP 0.5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000454", "type": "CDM"}, {"code": "68682092005", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TETRACYCLIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0120", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TETRACYCLINE HCL CAP 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000112", "type": "CDM"}, {"code": "69238152201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TGFBI GENE COMMON VARIANTS", "code_information": [{"code": "81333", "type": "CPT"}], "standard_charges": [{"minimum": 157.55, "maximum": 157.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 157.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TGSAP NSM LUNG NEO DNA&RNA23", "code_information": [{"code": "22U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TGSAP SL OR NEO DNA523&RNA55", "code_information": [{"code": "379U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THALITONE (CHLORTHALIDONE) 25MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002688", "type": "CDM"}, {"code": "70756001111", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THAW CRYOPRSVRD REPROD TISS", "code_information": [{"code": "89354", "type": "CPT"}], "standard_charges": [{"minimum": 10.58, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THAW PRESERVED STEM CELLS", "code_information": [{"code": "38208", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED EMBRYO", "code_information": [{"code": "89352", "type": "CPT"}], "standard_charges": [{"minimum": 10.58, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED OOCYTE", "code_information": [{"code": "89356", "type": "CPT"}], "standard_charges": [{"minimum": 7.54, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED SPERM", "code_information": [{"code": "89353", "type": "CPT"}], "standard_charges": [{"minimum": 10.58, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THEO-24 (THEOPHYLLINE ER) 200MG CAP.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001136", "type": "CDM"}, {"code": "52244020010", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 12.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE", "code_information": [{"code": "80198", "type": "CPT"}, {"code": "1000207", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.26, "maximum": 75.38, "gross_charge": 83.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 67.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 75.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 47.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE (AMINOPHYLLINE) 250/10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0280", "type": "HCPCS"}, {"code": "7000026", "type": "CDM"}, {"code": "00409592101", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE ER TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000115", "type": "CDM"}, {"code": "63629355101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE ER TAB 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000327", "type": "CDM"}, {"code": "62332002531", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THER BEHAV SVC, PER 15 MIN", "code_information": [{"code": "H2019", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER BEHAV SVC, PER DIEM", "code_information": [{"code": "H2020", "type": "HCPCS"}], "standard_charges": [{"minimum": 1671.13, "maximum": 1671.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1671.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER FOSTERCARE CHILD /MONTH", "code_information": [{"code": "S5146", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER FX NASAL INF TURBINATE", "code_information": [{"code": "30930", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER INDCTJ NTRABRN HYPTHRM", "code_information": [{"code": "776T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER INJECTION CARP TUNNEL", "code_information": [{"code": "20526", "type": "CPT"}], "standard_charges": [{"minimum": 767.67, "maximum": 767.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ 1ST 15 MIN", "code_information": [{"code": "97129", "type": "CPT"}], "standard_charges": [{"minimum": 22.1, "maximum": 22.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ EA ADDL 15 MIN", "code_information": [{"code": "97130", "type": "CPT"}], "standard_charges": [{"minimum": 21.12, "maximum": 21.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER NMA RDCTJ INTUS/OBSTRCJ", "code_information": [{"code": "74283", "type": "CPT"}], "standard_charges": [{"minimum": 334.74, "maximum": 334.74, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 334.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER NOT ASSESSED ANNUALLY", "code_information": [{"code": "G8855", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR CSF FLUOR/CT", "code_information": [{"code": "62329", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR DRG CSF", "code_information": [{"code": "62272", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ IA", "code_information": [{"code": "96373", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERA PAR DRUGS 2 OR > ADMIN", "code_information": [{"code": "D9612", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERA-M TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000666", "type": "CDM"}, {"code": "57896062101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THERAGENESIS, PER SQ CM", "code_information": [{"code": "A2008", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC ACTIVITIES", "code_information": [{"code": "97530", "type": "CPT"}], "standard_charges": [{"minimum": 34.82, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 244.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 62.32, "count": "1 through 10", "median_amount": 33.22, "methodology": "percent of total billed charges", "10th_percentile": 16.61, "90th_percentile": 129.86}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC EXERCISES", "code_information": [{"code": "97110", "type": "CPT"}], "standard_charges": [{"minimum": 27.93, "maximum": 763.85, "discounted_cash": 54.17, "estimated_discounted_cash": 212.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 113.91, "count": "1 through 10", "median_amount": 109.84, "methodology": "percent of total billed charges", "10th_percentile": 109.84, "90th_percentile": 146.45}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC LIGHTBOX TABLETP", "code_information": [{"code": "E0203", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PNEUMOTHORAX", "code_information": [{"code": "32960", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROCD STRG ENDUR", "code_information": [{"code": "G0237", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PULPOTOMY", "code_information": [{"code": "D3220", "type": "HCPCS"}], "standard_charges": [{"minimum": 451.64, "maximum": 451.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 451.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC ULTRAFILTRATION", "code_information": [{"code": "692T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERAPY ACTIVATION IPNSS", "code_information": [{"code": "93150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERAPY EXERCISE JOINT RX", "code_information": [{"code": "4018F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERASKIN", "code_information": [{"code": "Q4121", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THERMAZENE (SILVER SULFADIAZNE) CRM 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000457", "type": "CDM"}, {"code": "08880095055", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THERMOMETER DIGITAL", "code_information": [{"code": "3000371", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THERMOMETER KIT ORAL", "code_information": [{"code": "3000372", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THERMOMETER SHEATHS RECTAL", "code_information": [{"code": "3000374", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THERMOTABS 287MG-180MG-15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001043", "type": "CDM"}, {"code": "38485086335", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THIAMINE (VIT B-1) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000196", "type": "CDM"}, {"code": "77333093410", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THIAMINE 200MG/2ML INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J3411", "type": "HCPCS"}, {"code": "7000458", "type": "CDM"}, {"code": "63323001309", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 10.74, "maximum": 16.96, "gross_charge": 18.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIETHYLPERAZINE MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THIETHYLPERAZINE MALEATE10MG", "code_information": [{"code": "Q0174", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THIGH LENGTH SURG STOCKING", "code_information": [{"code": "A4495", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THIOPURINE METHYLTRANSFERASE ENZYME", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "1000849", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 27.7, "maximum": 96.2, "gross_charge": 106.89, "discounted_cash": 54.17, "estimated_discounted_cash": 106.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43336", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43337", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC AORTIC GRAFT", "code_information": [{"code": "33875", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38380", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38381", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38382", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC SURGERY SS", "code_information": [{"code": "G4035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOABDOMINAL GRAFT", "code_information": [{"code": "33877", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOP W/ESOPH MUSC EXC", "code_information": [{"code": "32665", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY BILOBECTOMY", "code_information": [{"code": "32670", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY CONTRL BLEEDING", "code_information": [{"code": "32654", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY DIAGNOSTIC", "code_information": [{"code": "32601", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY FOR LVRS", "code_information": [{"code": "32672", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY LYMPH NODE EXC", "code_information": [{"code": "32674", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY PNEUMONECTOMY", "code_information": [{"code": "32671", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REM TOTL CORTEX", "code_information": [{"code": "32652", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOV FB/FIBRIN", "code_information": [{"code": "32653", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE CORTEX", "code_information": [{"code": "32651", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE SEGMENT", "code_information": [{"code": "32669", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY RESECT BULLAE", "code_information": [{"code": "32655", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/ TH NRV EXC", "code_information": [{"code": "32664", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX INFILTRATE", "code_information": [{"code": "32607", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX MED SPACE", "code_information": [{"code": "32606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX NODULE", "code_information": [{"code": "32608", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX PLEURA", "code_information": [{"code": "32609", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/LOBECTOMY", "code_information": [{"code": "32663", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/MEDIAST EXC", "code_information": [{"code": "32662", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PERICARD EXC", "code_information": [{"code": "32661", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURECTOMY", "code_information": [{"code": "32656", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURODESIS", "code_information": [{"code": "32650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC DRAINAGE", "code_information": [{"code": "32659", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC FB REMOVE", "code_information": [{"code": "32658", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/THYMUS RESECT", "code_information": [{"code": "32673", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT ADDL", "code_information": [{"code": "32667", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT DIAG", "code_information": [{"code": "32668", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/WEDGE RESECT", "code_information": [{"code": "32666", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY WBX SAC", "code_information": [{"code": "32604", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/FLAP DRAINAGE", "code_information": [{"code": "32036", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/RIB RESECTION", "code_information": [{"code": "32035", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORAX STEREO RAD TARGETW/TX", "code_information": [{"code": "32701", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THOROCENTESIS SET", "code_information": [{"code": "3000600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 367.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36904", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36905", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36906", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROAT MUSCLE SURGERY", "code_information": [{"code": "43030", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROAT X-RAY & FLUOROSCOPY", "code_information": [{"code": "70370", "type": "CPT"}], "standard_charges": [{"minimum": 119.13, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 119.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}], "standard_charges": [{"minimum": 6.64, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME TITER", "code_information": [{"code": "85675", "type": "CPT"}], "standard_charges": [{"minimum": 7.88, "maximum": 11.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBLYTIC ART/VEN THERAPY", "code_information": [{"code": "37213", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBOEMB RISK ASSESSED", "code_information": [{"code": "1180F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBOLYSIS,CEREBRAL IV INFUSION", "code_information": [{"code": "37195", "type": "CPT"}, {"code": "11000292", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 509.01, "maximum": 966.98, "gross_charge": 893.0, "discounted_cash": 54.17, "estimated_discounted_cash": 893.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 669.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 714.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 803.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 509.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYSIS,CORONARY IV INFUSION", "code_information": [{"code": "92977", "type": "CPT"}, {"code": "11000291", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 509.01, "maximum": 803.7, "gross_charge": 893.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 669.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 714.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 803.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 509.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC ART THERAPY", "code_information": [{"code": "37211", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC VENOUS THERAPY", "code_information": [{"code": "37212", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBOMODULIN", "code_information": [{"code": "85337", "type": "CPT"}], "standard_charges": [{"minimum": 19.86, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN INHIBITION", "code_information": [{"code": "85705", "type": "CPT"}], "standard_charges": [{"minimum": 11.07, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THROMBOXANE URINE", "code_information": [{"code": "84431", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 40.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26820", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26842", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THUMB TENDON TRANSFER", "code_information": [{"code": "26510", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THXP APHERESIS W/HDL DELIP", "code_information": [{"code": "342T", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN W/ANTITHYROGLOBULIN AB", "code_information": [{"code": "86800", "type": "CPT"}, {"code": "1000343", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.3, "maximum": 103.37, "gross_charge": 95.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 76.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 85.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID ANTIBODIES", "code_information": [{"code": "86800", "type": "CPT"}, {"code": "1000038", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 18.3, "maximum": 103.37, "gross_charge": 94.14, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 75.31, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 84.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 53.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID ANTIBODIES-ASSOCIATED CHARGES", "code_information": [{"code": "86376", "type": "CPT"}, {"code": "1000652", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.73, "maximum": 103.37, "gross_charge": 86.13, "discounted_cash": 54.17, "estimated_discounted_cash": 86.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.9, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78013", "type": "CPT"}], "standard_charges": [{"minimum": 230.19, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 230.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78014", "type": "CPT"}], "standard_charges": [{"minimum": 282.74, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 282.74, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING", "code_information": [{"code": "78015", "type": "CPT"}], "standard_charges": [{"minimum": 273.7, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 273.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING BODY", "code_information": [{"code": "78018", "type": "CPT"}], "standard_charges": [{"minimum": 373.03, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 373.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING/STUDIES", "code_information": [{"code": "78016", "type": "CPT"}], "standard_charges": [{"minimum": 336.27, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 336.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROID MET UPTAKE", "code_information": [{"code": "78020", "type": "CPT"}], "standard_charges": [{"minimum": 101.11, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 101.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROID STIMULATING HORMONE", "code_information": [{"code": "84443", "type": "CPT"}, {"code": "1000050", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.32, "maximum": 89.5, "gross_charge": 99.45, "discounted_cash": 54.17, "estimated_discounted_cash": 99.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID STIMULATING IMMUNOGLOBULIN", "code_information": [{"code": "84445", "type": "CPT"}, {"code": "1000834", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 58.49, "maximum": 265.5, "gross_charge": 295.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 236.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 265.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 168.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID UPTAKE MEASUREMENT", "code_information": [{"code": "78012", "type": "CPT"}], "standard_charges": [{"minimum": 100.22, "maximum": 1224.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 100.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1224.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [{"code": "626", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC", "code_information": [{"code": "625", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "627", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "THYROTROPIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3240", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THYROTROPIN RECEPTOR Ab", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "1000778", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.86, "maximum": 68.98, "gross_charge": 76.65, "discounted_cash": 54.17, "estimated_discounted_cash": 76.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC ADD-ON", "code_information": [{"code": "37232", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STENT & ATHER", "code_information": [{"code": "37231", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STNT & ATHER", "code_information": [{"code": "37235", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/ATHER", "code_information": [{"code": "37229", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/STENT", "code_information": [{"code": "37230", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/TLA", "code_information": [{"code": "37228", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTHROSCOPY/SURGERY", "code_information": [{"code": "29855", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTHROSCOPY/SURGERY", "code_information": [{"code": "29856", "type": "CPT"}], "standard_charges": [{"minimum": 17846.52, "maximum": 17846.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17846.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIBPER REVASC W/ATHER ADD-ON", "code_information": [{"code": "37233", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIC-BRN ENCEPH VAC 0.25ML IM", "code_information": [{"code": "90626", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIC-BRN ENCEPH VAC 0.5ML IM", "code_information": [{"code": "90627", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TILT TABLE EVALUATION", "code_information": [{"code": "93660", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIMOLOL 0.25% OPHTHALMIC GEL-FORMING S", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001171", "type": "CDM"}, {"code": "43598074711", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 469.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TINNITUS ASSESSMENT", "code_information": [{"code": "92625", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TINZAPARIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1655", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIROFIBAN HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3246", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL EA ADDL", "code_information": [{"code": "33746", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ADDL 30 SQ CM", "code_information": [{"code": "14302", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ANY 30.1-60 SQ CM", "code_information": [{"code": "14301", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L 10 SQ CM/<", "code_information": [{"code": "14060", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L10.1-30SQCM", "code_information": [{"code": "14061", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR F/C/C/M/N/A/G/H/F", "code_information": [{"code": "14040", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR F/C/C/M/N/A/G/H/F", "code_information": [{"code": "14041", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10 SQ CM/<", "code_information": [{"code": "14020", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10.1-30 SQCM", "code_information": [{"code": "14021", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR TRUNK 10 SQ CM/<", "code_information": [{"code": "14000", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR TRUNK 10.1-30SQCM", "code_information": [{"code": "14001", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISAGENLECLEUCEL CAR-POS T", "code_information": [{"code": "Q2042", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISS EXAM MOLECULAR STUDY", "code_information": [{"code": "88387", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 38.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT NONRESORB", "code_information": [{"code": "D7957", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT RESORB", "code_information": [{"code": "D7956", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISS TRNSGLTMNASE EA IG CLAS", "code_information": [{"code": "86364", "type": "CPT"}], "standard_charges": [{"minimum": 13.26, "maximum": 13.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISS XPNDR PLMT BRST RCNSTJ", "code_information": [{"code": "19357", "type": "CPT"}], "standard_charges": [{"minimum": 21736.36, "maximum": 21736.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 21736.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE BONE MARROW", "code_information": [{"code": "88237", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 165.31, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 165.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE PLACENTA", "code_information": [{"code": "88235", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 172.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 172.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE SKIN/BIOPSY", "code_information": [{"code": "88233", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 161.84, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 161.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE TUMOR", "code_information": [{"code": "88239", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 169.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 169.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE EXAM BY PATHOLOGIST", "code_information": [{"code": "88302", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 33.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE EXAM BY PATHOLOGIST", "code_information": [{"code": "88307", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 304.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 304.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE EXAM BY PATHOLOGIST", "code_information": [{"code": "88309", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 463.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 463.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE EXAM FOR FUNGI", "code_information": [{"code": "87220", "type": "CPT"}], "standard_charges": [{"minimum": 4.91, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE HOMOGENIZATION CULTR", "code_information": [{"code": "87176", "type": "CPT"}], "standard_charges": [{"minimum": 6.76, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE IN-SITU HYBRIDIZATION", "code_information": [{"code": "D0479", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.12, "maximum": 92.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE LOCALIZATION-EXCISION", "code_information": [{"code": "C1819", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE PATHOLOGY", "code_information": [{"code": "88304", "type": "CPT"}, {"code": "1200001", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 30.71, "maximum": 120.69, "gross_charge": 134.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 107.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 120.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 76.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE REGEN NON-RESORBABLE", "code_information": [{"code": "D6107", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISSUE REGEN RESORBABLE", "code_information": [{"code": "D6106", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TL201 THALLIUM", "code_information": [{"code": "A9505", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS 250 G OR LESS", "code_information": [{"code": "58570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS OVER 250 G", "code_information": [{"code": "58572", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O 250 G OR LESS", "code_information": [{"code": "58571", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O UTERUS OVER 250 G", "code_information": [{"code": "58573", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMA/TMAO PRFL MS/MS UR ALG", "code_information": [{"code": "256U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DEBRIDEMENT", "code_information": [{"code": "D7877", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISC REPOSIT", "code_information": [{"code": "D7874", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISCECTOMY", "code_information": [{"code": "D7876", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY LYSIS ADHESN", "code_information": [{"code": "D7873", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY SYNOVECTOMY", "code_information": [{"code": "D7875", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ ASPIRATION JOINT FLUID", "code_information": [{"code": "D7870", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING INTO JOINT", "code_information": [{"code": "D7860", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING OF A MUSCLE", "code_information": [{"code": "D7856", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ DIAGNOSTIC ARTHROSCOPY", "code_information": [{"code": "D7872", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ EXCISN OF JOINT MEMBRANE", "code_information": [{"code": "D7854", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ MANIPULATION UNDER ANEST", "code_information": [{"code": "D7830", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ MENISCECTOMY", "code_information": [{"code": "D7850", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ OPEN REDUCT-DISLOCATION", "code_information": [{"code": "D7810", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ RECONSTRUCTION", "code_information": [{"code": "D7858", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ REPAIR OF JOINT DISC", "code_information": [{"code": "D7852", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ RESHAPING COMPONENTS", "code_information": [{"code": "D7865", "type": "HCPCS"}], "standard_charges": [{"minimum": 22863.16, "maximum": 22863.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 22863.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMJ UNSPECIFIED THERAPY", "code_information": [{"code": "D7899", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMPST AUTO TUBE DLVR SYS", "code_information": [{"code": "583T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANEOUS APPROACH", "code_information": [{"code": "483T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMVI TRANSTHORACIC EXPOSURE", "code_information": [{"code": "484T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TNKASE (TENECTEPLASE) 50MG", "drug_information": {"unit": 50.0, "type": "EA"}, "code_information": [{"code": "J3101", "type": "HCPCS"}, {"code": "72004328", "type": "CDM"}, {"code": "50242017601", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 276.9, "maximum": 16454.23, "gross_charge": 485.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 364.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 388.63, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 437.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 276.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TNOT OPN ELBW TO SHO EA TDN", "code_information": [{"code": "24310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBACCO COUNSELING", "code_information": [{"code": "D1320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBACCO NON-USER", "code_information": [{"code": "1036F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBACCO NON-USER", "code_information": [{"code": "M1316", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBACCO NONSMOKER NOR 2NDHND", "code_information": [{"code": "1033F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBACCO USE ASSESSED", "code_information": [{"code": "1000F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBACCO USE TXMNT COUNSELING", "code_information": [{"code": "4000F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBACCO USE TXMNT PHARMACOL", "code_information": [{"code": "4001F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBRADEX (NF-TOBRADEX) Ophth Susp 0.3%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002063", "type": "CDM"}, {"code": "24208029525", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOBRAMYCIAN PEAK", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "1000803", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.55, "maximum": 80.7, "gross_charge": 89.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 71.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 80.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 51.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIAN TROUGH", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "1000804", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.55, "maximum": 80.7, "gross_charge": 89.67, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 71.73, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 80.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 51.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7685", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7682", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN SULFATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOC TOOL INCL ELEM NOT USED", "code_information": [{"code": "G9658", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOC TOOL INCL KEY ELEM", "code_information": [{"code": "G9655", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOCILIZUMAB FOR COVID-19", "code_information": [{"code": "Q0249", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOCILIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3262", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOE JOINT TRANSFER", "code_information": [{"code": "26556", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOFRANIL (NF-IMIPRAMINE HCL) 10MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001185", "type": "CDM"}, {"code": "49884005401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOILET RAIL", "code_information": [{"code": "E0243", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOILET SEAT RAISED", "code_information": [{"code": "E0244", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOMO BITEWING IMAGE", "code_information": [{"code": "D0373", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOMO COMP SERIES IMAGES", "code_information": [{"code": "D0372", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOMO PERIAPICAL IMAGE", "code_information": [{"code": "D0374", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOMOSYNTHESIS, MAMMO", "code_information": [{"code": "G0279", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.54, "maximum": 161.54, "discounted_cash": 54.17, "estimated_discounted_cash": 160.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 161.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONE DECAY HEARING TEST", "code_information": [{"code": "92563", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONER E250A21A FOR E250", "code_information": [{"code": "80000852", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 150.72, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TONGUE AND NECK SURGERY", "code_information": [{"code": "41135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE BASE VOL REDUCTION", "code_information": [{"code": "41530", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE JAW & NECK SURGERY", "code_information": [{"code": "41155", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH JAW SURGERY", "code_information": [{"code": "41150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH NECK SURGERY", "code_information": [{"code": "41153", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE REMOVAL NECK SURGERY", "code_information": [{"code": "41145", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE SUSPENSION", "code_information": [{"code": "41512", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE TO LIP SURGERY", "code_information": [{"code": "41510", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOOTH PIN RETENTION", "code_information": [{"code": "D2951", "type": "HCPCS"}], "standard_charges": [{"minimum": 6135.05, "maximum": 6135.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6135.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOOTH REIMPLANTATION", "code_information": [{"code": "D7270", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOOTH ROOT REMOVAL", "code_information": [{"code": "D7250", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOOTH SPLITTING", "code_information": [{"code": "D3920", "type": "HCPCS"}], "standard_charges": [{"minimum": 818.21, "maximum": 818.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 818.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOOTH TRANSPLANTATION", "code_information": [{"code": "D7272", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOOTHBRUSH", "code_information": [{"code": "3000046", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOOTHETTE", "code_information": [{"code": "3000047", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOOTHPASTE", "code_information": [{"code": "3000048", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOPAMAX (TOPIRAMATE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000806", "type": "CDM"}, {"code": "68084034401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOPAMAX (TOPIRAMATE) TAB 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000523", "type": "CDM"}, {"code": "50458064265", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOPAMAX (TOPIRAMATE) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000632", "type": "CDM"}, {"code": "68382013805", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOPAMAX (TOPIRAMATE) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001015", "type": "CDM"}, {"code": "68382013914", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOPAMAX LEVEL", "code_information": [{"code": "80201", "type": "CPT"}, {"code": "1000209", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.71, "maximum": 90.0, "gross_charge": 100.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPICAL ANESTHETIC, PER GRAM", "code_information": [{"code": "A4736", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOPICAL APP FLUORID EX VRNSH", "code_information": [{"code": "D1208", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "D1206", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOPICAL OX DELIVER SYS, NOS", "code_information": [{"code": "E0446", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOPICAL PREP RX AOE", "code_information": [{"code": "4130F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOPOGRAPHIC BRAIN MAPPING", "code_information": [{"code": "S8040", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOPOTECAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9351", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.5, "maximum": 199.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOPOTECAN ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8705", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.21, "maximum": 1147.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOPROL XL (METOPROLOL SUCC) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000896", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOPROL XL (METOPROLOL SUCC) TAB 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000460", "type": "CDM"}, {"code": "00904632206", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOPROL XL (METOPROLOL SUCC) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000461", "type": "CDM"}, {"code": "60687040265", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TORADOL (KETOROLAC) 10MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001062", "type": "CDM"}, {"code": "70710171001", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TORADOL (KETOROLAC) 30MG INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J1885", "type": "HCPCS"}, {"code": "7000260", "type": "CDM"}, {"code": "65145014525", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 13.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORADOL KETOROLAC 60MG INJ", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J1885", "type": "HCPCS"}, {"code": "72000915", "type": "CDM"}, {"code": "63323016214", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 13.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORSION MECHANISM KNEE/ANKLE", "code_information": [{"code": "L2861", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TORSION MECHANISM WRIST/ELBO", "code_information": [{"code": "L3891", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22856", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22857", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2ND LVL CRV", "code_information": [{"code": "22858", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2NTRSPC LMBR", "code_information": [{"code": "22860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOT ESTRADIOL RESPONSE PANEL", "code_information": [{"code": "80415", "type": "CPT"}], "standard_charges": [{"minimum": 64.27, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 64.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ARTHROPLASTY", "code_information": [{"code": "27130", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ARTHROPLASTY", "code_information": [{"code": "27132", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP RESURFACING", "code_information": [{"code": "S2118", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58152", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ARTHROPLASTY", "code_information": [{"code": "27447", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL LUNG LAVAGE", "code_information": [{"code": "32997", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL PORPHYRIN PLASMA", "code_information": [{"code": "84311", "type": "CPT"}, {"code": "1000857", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.32, "maximum": 38.72, "gross_charge": 40.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL PROT URINE RDM", "code_information": [{"code": "84156", "type": "CPT"}, {"code": "1000159", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.22, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "estimated_discounted_cash": 21.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL PROTEIN -BODY FLUID", "code_information": [{"code": "84157", "type": "CPT"}, {"code": "1000702", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.6, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL PROTEIN SERUM", "code_information": [{"code": "84155", "type": "CPT"}, {"code": "1000160", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.22, "maximum": 19.52, "gross_charge": 21.69, "discounted_cash": 54.17, "estimated_discounted_cash": 21.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL, per square centimeter", "code_information": [{"code": "Q4330", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAZOLINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2670", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOUCH QUANT SENSORY TEST", "code_information": [{"code": "106T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOUJEO INSULIN 300U/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002638", "type": "CDM"}, {"code": "00024586903", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 403.93, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOURNIQUET FOR DIALYSIS, EA", "code_information": [{"code": "A4929", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOVIAZ 4MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001054", "type": "CDM"}, {"code": "67877006430", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.24, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOWELETTES OBSTETRIC", "code_information": [{"code": "3001239", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TOXOPLASMA ANTIBODY", "code_information": [{"code": "86777", "type": "CPT"}], "standard_charges": [{"minimum": 16.55, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA ANTIBODY IGM", "code_information": [{"code": "86778", "type": "CPT"}], "standard_charges": [{"minimum": 16.57, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TP53 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81351", "type": "CPT"}], "standard_charges": [{"minimum": 738.13, "maximum": 738.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 738.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TP53 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81353", "type": "CPT"}], "standard_charges": [{"minimum": 354.2, "maximum": 354.2, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 354.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TP53 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81352", "type": "CPT"}], "standard_charges": [{"minimum": 378.94, "maximum": 378.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 378.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPA INITI W/IN 4.5 HR", "code_information": [{"code": "G8600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPMT GENE COM VARIANTS", "code_information": [{"code": "81335", "type": "CPT"}], "standard_charges": [{"minimum": 201.03, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPMT NUDT15 GENES", "code_information": [{"code": "34U", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV ADJMT", "code_information": [{"code": "53454", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV BI", "code_information": [{"code": "53451", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV RMVL EA", "code_information": [{"code": "53453", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV UNI", "code_information": [{"code": "53452", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL FOCAL ABLTJ MAL PRST8", "code_information": [{"code": "655T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL LSR ABLT B9 PRST8 HYPR", "code_information": [{"code": "714T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPRNL PLMT BIODEGRDABL MATRL", "code_information": [{"code": "55874", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TR RETINAL LES PRETERM INF", "code_information": [{"code": "67229", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRABECULOPLASTY LASER SURG", "code_information": [{"code": "65855", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INT LSR W/SCP", "code_information": [{"code": "622T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INTERNO LASER", "code_information": [{"code": "621T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRABECULOTOMY LSR W/OCT GDN", "code_information": [{"code": "730T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAC SM BLACK DRESSING", "code_information": [{"code": "3001139", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 62.14, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRACH SHILEY TUBE SZ 8", "code_information": [{"code": "3001351", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 324.84, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRACH SUPPLY NOC", "code_information": [{"code": "S8189", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACH. INNER CANNULA SZ 6 DISP.", "code_information": [{"code": "3001284", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRACH. INNER CANNULA SZ 6.5 DISP.", "code_information": [{"code": "3001449", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRACH. TUBE CUFFLESS NEONATAL SZ 3.5", "code_information": [{"code": "3001285", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 11.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRACHEO-ESOPHAGOPLASTY CONG", "code_information": [{"code": "43314", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [{"code": "12", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [{"code": "11", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC", "code_information": [{"code": "13", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY SHOWER PROTECT", "code_information": [{"code": "A7523", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [{"code": "4", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRADJENTA (LINAGLIPTIN) 5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001057", "type": "CDM"}, {"code": "00597014030", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 49.37, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRANS BENCH W/WO COMM OPEN", "code_information": [{"code": "E0247", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANS ELEC NERV PERIPH NERV", "code_information": [{"code": "A4540", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANS OR SIGN LANGUAGE SVCS", "code_information": [{"code": "D9990", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43332", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43333", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSABDOM AMNIOINFUS W/US", "code_information": [{"code": "59070", "type": "CPT"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF ASD", "code_information": [{"code": "93580", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF VSD", "code_information": [{"code": "93581", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH EMBOLIZ MICROSPHER", "code_information": [{"code": "S2095", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH INTRAOP MICROINF", "code_information": [{"code": "C9759", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH MTRAL VLVE REPAIR", "code_information": [{"code": "345T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION CNS", "code_information": [{"code": "61624", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION NON-CNS", "code_information": [{"code": "61626", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/EPS", "code_information": [{"code": "37215", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/O EPS", "code_information": [{"code": "37216", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATHETER BIOPSY", "code_information": [{"code": "37200", "type": "CPT"}], "standard_charges": [{"minimum": 2015.39, "maximum": 2015.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2015.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCOCHLEAR APPROACH/SKULL", "code_information": [{"code": "61596", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCONDYLAR APPROACH/SKULL", "code_information": [{"code": "61597", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCRV ABLTJ UTRN FIBRD RF", "code_information": [{"code": "58580", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS CARBOXYHB", "code_information": [{"code": "88740", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS METHB", "code_information": [{"code": "88741", "type": "CPT"}], "standard_charges": [{"minimum": 10.78, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCYTE, PER SQ CENTIMETER", "code_information": [{"code": "Q4182", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MEASUREMENTS", "code_information": [{"code": "602T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MONITORING", "code_information": [{"code": "603T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSDUCER PROTECT/FLD BAR", "code_information": [{"code": "E1575", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSECT ARTERY SINUS", "code_information": [{"code": "61611", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSECT PULMONARY ARTERY", "code_information": [{"code": "33922", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSESOPH DOPPL CARDIAC MON", "code_information": [{"code": "G9157", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER CARE CHECKLIST USED", "code_information": [{"code": "583F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ABDOMINAL MUSCLE", "code_information": [{"code": "27100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58974", "type": "CPT"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58976", "type": "CPT"}], "standard_charges": [{"minimum": 1314.1, "maximum": 1314.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1314.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27110", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27111", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF SPINAL MUSCLE", "code_information": [{"code": "27105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER SKIN PEDICLE FLAP", "code_information": [{"code": "15650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER TENDON TO PELVIS", "code_information": [{"code": "27098", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFER TUB RAIL ATTACHMENT", "code_information": [{"code": "E0246", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSFERRIN", "code_information": [{"code": "84466", "type": "CPT"}, {"code": "1000115", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.67, "maximum": 68.01, "gross_charge": 75.57, "discounted_cash": 54.17, "estimated_discounted_cash": 101.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 60.45, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "1000269", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 445.35, "maximum": 1469.15, "gross_charge": 781.32, "discounted_cash": 54.17, "estimated_discounted_cash": 1211.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 585.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 625.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 703.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 445.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [{"code": "69", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRANSJ CARE MGMT HIGH F2F 7D", "code_information": [{"code": "99496", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSJ CARE MGMT MOD F2F 14D", "code_information": [{"code": "99495", "type": "CPT"}], "standard_charges": [{"minimum": 330.72, "maximum": 330.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 330.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSORL LWR ESOPHGL MYOTOMY", "code_information": [{"code": "43497", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPERI NEEDLE PLACE PROS", "code_information": [{"code": "55875", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPETROSAL APPROACH/SKULL", "code_information": [{"code": "61598", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPL ALLOGRAFT PANCREAS", "code_information": [{"code": "48554", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FEMUR RIDGE", "code_information": [{"code": "27140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25310", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25312", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT HAND TENDON", "code_information": [{"code": "26480", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT OF THIGH TENDON", "code_information": [{"code": "27396", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT PALM TENDON", "code_information": [{"code": "26485", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT RELATED PER DIEM", "code_information": [{"code": "S9975", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT URETER TO SKIN", "code_information": [{"code": "50860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT HAND TENDON", "code_information": [{"code": "26483", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT PALM TENDON", "code_information": [{"code": "26489", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION HEART/LUNG", "code_information": [{"code": "33935", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF HEART", "code_information": [{"code": "33945", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50360", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50365", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF LIVER", "code_information": [{"code": "47135", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF MULTIVISC", "code_information": [{"code": "S2054", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF SMALL INT", "code_information": [{"code": "S2053", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTS OF THIGH TENDONS", "code_information": [{"code": "27397", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLJ HEMATOPOIETIC BOOST", "code_information": [{"code": "38243", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO HCT/DONOR", "code_information": [{"code": "38240", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO LYMPHOCYTES", "code_information": [{"code": "38242", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLT AUTOL HCT/DONOR", "code_information": [{"code": "38241", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PARKING FEES/TOLLS", "code_information": [{"code": "A0170", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORT X-RAY MULTIPL", "code_information": [{"code": "R0075", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE EKG", "code_information": [{"code": "R0076", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE X-RAY", "code_information": [{"code": "R0070", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPORTATION COSTS TO AND", "code_information": [{"code": "S9992", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPORTATION FEE", "code_information": [{"code": "1400006", "type": "CDM"}, {"code": "380", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRANSPOSITION OF VEIN VALVE", "code_information": [{"code": "34510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OVARY(S)", "code_information": [{"code": "58825", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSSEPTAL FIBEROTOMY", "code_information": [{"code": "D7291", "type": "HCPCS"}], "standard_charges": [{"minimum": 6136.58, "maximum": 6136.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6136.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSTEMPORAL APPROACH/SKULL", "code_information": [{"code": "61595", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR CATH FOR STENT", "code_information": [{"code": "33621", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43334", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43335", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [{"code": "669", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [{"code": "668", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "670", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITH CC/MCC", "code_information": [{"code": "713", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "714", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RF TREATMENT", "code_information": [{"code": "53860", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSVAGINAL US OBSTETRIC", "code_information": [{"code": "76817", "type": "CPT"}], "standard_charges": [{"minimum": 119.75, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 119.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSVRS A-ARCH GRF HYPTHRM", "code_information": [{"code": "33871", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANXENE (CLORAZEPATE DIPOT) TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001064", "type": "CDM"}, {"code": "60505475601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 5.16, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRANXENE (CLORAZEPATE DIPOT) TAB 3.75", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000816", "type": "CDM"}, {"code": "13107031901", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRANXENE (CLORAZEPATE DIPOT) TAB 7.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001063", "type": "CDM"}, {"code": "51672404301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.42, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAUMA RESPONS W/HOSP CRITI", "code_information": [{"code": "G0390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [{"code": "604", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [{"code": "605", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITH MCC", "code_information": [{"code": "913", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [{"code": "914", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [{"code": "86", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [{"code": "85", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "87", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [{"code": "83", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [{"code": "82", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "84", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "TRAVATAN Z OPHTHALMIC SOLUTION 0.004%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000891", "type": "CDM"}, {"code": "00078094640", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 655.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAY EAR/NOSE", "code_information": [{"code": "3000379", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAY EYE", "code_information": [{"code": "3000380", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAY FOLEY CATH 14FR (I&O)", "code_information": [{"code": "3001434", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAY FOLEY CATH 16FR", "code_information": [{"code": "3000592", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAY FOLEY CATH 18FR", "code_information": [{"code": "3000593", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.91, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAY FOLEY IRRIGATIO", "code_information": [{"code": "3000594", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAY SUTURE REMOVAL", "code_information": [{"code": "3000599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAY TRACH CLEANING", "code_information": [{"code": "3000601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAZODONE HCL TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000480", "type": "CDM"}, {"code": "00904686961", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAZODONE HCL TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000450", "type": "CDM"}, {"code": "60687044301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRAZODONE LEVEL", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "1000923", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 27.7, "maximum": 96.2, "gross_charge": 106.89, "discounted_cash": 54.17, "estimated_discounted_cash": 106.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRB@ GENE REARRANGE AMPLIFY", "code_information": [{"code": "81340", "type": "CPT"}], "standard_charges": [{"minimum": 240.26, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 240.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRB@ GENE REARRANGE DIRPROBE", "code_information": [{"code": "81341", "type": "CPT"}], "standard_charges": [{"minimum": 57.03, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 57.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRCATH REPLACE AORTIC VALVE", "code_information": [{"code": "33366", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27840", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27842", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27846", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27848", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE FRACTURE", "code_information": [{"code": "28445", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28490", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28495", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28496", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28505", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CHEST LINING", "code_information": [{"code": "32215", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21431", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21432", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21433", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21435", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21436", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21440", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21445", "type": "CPT"}], "standard_charges": [{"minimum": 9282.97, "maximum": 9282.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9282.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT EACH ADD SPINE FX", "code_information": [{"code": "22328", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59120", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59121", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59130", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59136", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59140", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59150", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59151", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24605", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24615", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24586", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24587", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24620", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24635", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26775", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26785", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26720", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26725", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26727", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26735", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26740", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26742", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26746", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26750", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26765", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT BONE LESION", "code_information": [{"code": "28005", "type": "CPT"}], "standard_charges": [{"minimum": 16691.68, "maximum": 16691.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16691.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28540", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28545", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28546", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28570", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28575", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28576", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28605", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28606", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FOREARM BONE LESION", "code_information": [{"code": "25035", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25515", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25525", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25526", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25535", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25545", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25565", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25574", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25575", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE ULNAR STYLOID", "code_information": [{"code": "25652", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FX DISTAL RADIAL", "code_information": [{"code": "25606", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FX RAD EXTRA-ARTICUL", "code_information": [{"code": "25607", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FX RAD INTRA-ARTICUL", "code_information": [{"code": "25608", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT FX RADIAL 3+ FRAG", "code_information": [{"code": "25609", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HAND BONE LESION", "code_information": [{"code": "26034", "type": "CPT"}], "standard_charges": [{"minimum": 4227.04, "maximum": 4227.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4227.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26670", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26675", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26685", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26686", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HEEL FRACTURE", "code_information": [{"code": "28415", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27250", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27252", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27253", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27254", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27256", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27257", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27258", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27259", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27265", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27266", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27227", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27228", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27222", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP WALL FRACTURE", "code_information": [{"code": "27226", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24515", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24516", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24538", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24545", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24546", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24565", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24566", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24575", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24576", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24577", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24579", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24582", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27552", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27556", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27557", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27558", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27532", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27535", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27536", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27540", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE(S)", "code_information": [{"code": "27538", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27562", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27566", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27524", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26700", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26705", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26715", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21450", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21451", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21452", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21453", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21454", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21461", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21462", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21465", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21470", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG BONE LESION", "code_information": [{"code": "27607", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27831", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27832", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27824", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27825", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27826", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27827", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27828", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG JOINT", "code_information": [{"code": "27829", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26605", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26607", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26608", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26615", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28470", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28475", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28476", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28485", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE", "code_information": [{"code": "28456", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28455", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28465", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21421", "type": "CPT"}], "standard_charges": [{"minimum": 14583.21, "maximum": 14583.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 14583.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21422", "type": "CPT"}], "standard_charges": [{"minimum": 11133.76, "maximum": 11133.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 11133.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21423", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT NECK SPINE FRACTURE", "code_information": [{"code": "22326", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/GRAFT", "code_information": [{"code": "22319", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/O GRAFT", "code_information": [{"code": "22318", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC FRACTURE(S)", "code_information": [{"code": "27215", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27216", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27217", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27218", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54111", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54112", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT PLEURODESIS W/AGENT", "code_information": [{"code": "32560", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24655", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24665", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24666", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28530", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28531", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62000", "type": "CPT"}], "standard_charges": [{"minimum": 4389.92, "maximum": 4389.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4389.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62005", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27175", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27176", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27177", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27178", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27181", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CANAL LESION", "code_information": [{"code": "62282", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62280", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62281", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SPINE FRACTURE", "code_information": [{"code": "22325", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21820", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21825", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27200", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27202", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27230", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27232", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27235", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27236", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27238", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27240", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27244", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27245", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27246", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27248", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27516", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27517", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27519", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THORAX SPINE FRACTURE", "code_information": [{"code": "22327", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26645", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26650", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26665", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28630", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28635", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28636", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28660", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28665", "type": "CPT"}], "standard_charges": [{"minimum": 3150.59, "maximum": 3150.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3150.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28666", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TOE FRACTURE", "code_information": [{"code": "28525", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL NERVE", "code_information": [{"code": "61790", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL TRACT", "code_information": [{"code": "61791", "type": "CPT"}], "standard_charges": [{"minimum": 3702.16, "maximum": 3702.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24670", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24675", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24685", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT UTERUS INFECTION", "code_information": [{"code": "59830", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINA INFECTION", "code_information": [{"code": "57150", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINAL BLEEDING", "code_information": [{"code": "57180", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25622", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25624", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25628", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25630", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25635", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25645", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25650", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25660", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25670", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25675", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25676", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25690", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25695", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25680", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25685", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT/GRAFT HEEL FRACTURE", "code_information": [{"code": "28420", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATED WATER PER GALLON", "code_information": [{"code": "A4714", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT MOUTH ROOF LESION", "code_information": [{"code": "42160", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46940", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46942", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27786", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27792", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27808", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27810", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27814", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27816", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27818", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27822", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27823", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28430", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28435", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28436", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BLADDER LESION", "code_information": [{"code": "51720", "type": "CPT"}], "standard_charges": [{"minimum": 82.9, "maximum": 82.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 82.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BONE CYST", "code_information": [{"code": "20615", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CHOROID LESION", "code_information": [{"code": "67220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF COMPLICATIONS", "code_information": [{"code": "D9930", "type": "HCPCS"}], "standard_charges": [{"minimum": 745.16, "maximum": 745.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 745.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CORNEAL LESION", "code_information": [{"code": "65450", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF EYELID LESIONS", "code_information": [{"code": "68040", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27780", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27781", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27784", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28002", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28003", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF GUM LESION", "code_information": [{"code": "41850", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEAD INJURY", "code_information": [{"code": "62010", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28400", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28405", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28406", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59812", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59821", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MOUTH LESION", "code_information": [{"code": "40820", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54110", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54115", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54200", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54205", "type": "CPT"}], "standard_charges": [{"minimum": 6266.27, "maximum": 6266.27, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6266.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54220", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RECTAL PROLAPSE", "code_information": [{"code": "45520", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67208", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67210", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67218", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21812", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21813", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27502", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27503", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27506", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27507", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27508", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27509", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27510", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27511", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27513", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27514", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27750", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27752", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27756", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27758", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27759", "type": "CPT"}], "standard_charges": [{"minimum": 16953.93, "maximum": 16953.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16953.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28510", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28515", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53220", "type": "CPT"}], "standard_charges": [{"minimum": 17066.65, "maximum": 17066.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17066.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53260", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53265", "type": "CPT"}], "standard_charges": [{"minimum": 9375.66, "maximum": 9375.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9375.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT PLAN DEVELOPMENT", "code_information": [{"code": "T1007", "type": "HCPCS"}], "standard_charges": [{"minimum": 214.57, "maximum": 214.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT ROOM (FOR INJECTION/BLD)", "code_information": [{"code": "G0463", "type": "HCPCS"}, {"code": "10000005", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 194.4, "maximum": 306.96, "gross_charge": 341.07, "discounted_cash": 54.17, "estimated_discounted_cash": 323.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 255.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 272.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 306.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 194.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT X10SV RETINOPATHY", "code_information": [{"code": "67228", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATROOM CHF CLINIC", "code_information": [{"code": "G0463", "type": "HCPCS"}, {"code": "10000008", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 194.4, "maximum": 306.96, "gross_charge": 341.07, "discounted_cash": 54.17, "estimated_discounted_cash": 323.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 255.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 272.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 306.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 194.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRELEGY ELLIPTA 100/62.5/25MCG/INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003805", "type": "CDM"}, {"code": "00173088710", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2042.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AB(FTA-ABS)", "code_information": [{"code": "86780", "type": "CPT"}, {"code": "1000056", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.23, "maximum": 96.7, "gross_charge": 78.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.71, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AG IF", "code_information": [{"code": "87285", "type": "CPT"}], "standard_charges": [{"minimum": 14.01, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREPROSTINIL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3285", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREPROSTINIL, NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7686", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRESIBA FLEXTOUCH INSULIN PEN 100U/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001980", "type": "CDM"}, {"code": "00169266015", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRESIBA FLEXTOUCH INSULIN PEN 200U/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "72001010", "type": "CDM"}, {"code": "00169255013", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.14, "maximum": 1.8, "gross_charge": 2.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRETINOIN TOPICAL 5 G", "code_information": [{"code": "S0117", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRG GENE REARRANGEMENT ANAL", "code_information": [{"code": "81342", "type": "CPT"}], "standard_charges": [{"minimum": 231.73, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 231.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 311+", "code_information": [{"code": "239U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 55-74", "code_information": [{"code": "242U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 83+", "code_information": [{"code": "326U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL DNA 23", "code_information": [{"code": "171U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 194 GENES", "code_information": [{"code": "50U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 324 GENES", "code_information": [{"code": "37U", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRH STIMULATION PANEL", "code_information": [{"code": "80438", "type": "CPT"}], "standard_charges": [{"minimum": 57.97, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRH STIMULATION PANEL", "code_information": [{"code": "80439", "type": "CPT"}], "standard_charges": [{"minimum": 77.29, "maximum": 103.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 77.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRI-COR (NF-FENOFIBRATE) 160MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002427", "type": "CDM"}, {"code": "70756021590", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRIAGE CARDIAC PANEL", "code_information": [{"code": "1000462", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 72.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE A INJ PRS-FREE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3300", "type": "HCPCS"}], "standard_charges": [{"minimum": 267.21, "maximum": 267.21, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE ACE 0.1% ORAL PASTE 5GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000749", "type": "CDM"}, {"code": "51672126705", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 104.64, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE ACETONIDE 0.1% CRM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000466", "type": "CDM"}, {"code": "51672128202", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 8.73, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7683", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7684", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE DIACETATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3302", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE HEXACETONL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3303", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRICHINELLA ANTIBODY", "code_information": [{"code": "86784", "type": "CPT"}], "standard_charges": [{"minimum": 14.44, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRICHOGRAM", "code_information": [{"code": "96902", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS ASSAY W/OPTIC", "code_information": [{"code": "87808", "type": "CPT"}], "standard_charges": [{"minimum": 17.58, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS VAGIN DIR PROBE", "code_information": [{"code": "87660", "type": "CPT"}], "standard_charges": [{"minimum": 23.06, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS VAGINALIS AMPLIF", "code_information": [{"code": "87661", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRICON (NF-MULTIVIT/MULTIMIN) TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000781", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRICOR (FENOFIBRATE) 54MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004023", "type": "CDM"}, {"code": "70756021490", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRICOR (FENOFIBRATE) TAB 145MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000267", "type": "CDM"}, {"code": "60687062921", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 12.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRICYCLIC & CYCLICALS 6/MORE", "code_information": [{"code": "80337", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIFLUPROMAZINE HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3400", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIFOC PRSCRP LENS", "code_information": [{"code": "S0508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIGEMINAL BLOCK ANESTHESIA", "code_information": [{"code": "D9212", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.72, "maximum": 112.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 112.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIGGER POINT INJECTION TECH", "code_information": [{"code": "20550", "type": "CPT"}, {"code": "11000217", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 418.43, "maximum": 767.67, "gross_charge": 734.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 587.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 660.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 418.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIGLYCERIDES", "code_information": [{"code": "84478", "type": "CPT"}, {"code": "1000212", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.6, "maximum": 30.64, "gross_charge": 34.05, "discounted_cash": 54.17, "estimated_discounted_cash": 34.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 27.24, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRILEPTAL (OXCARBAZEPINE) 150MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003568", "type": "CDM"}, {"code": "51991029205", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRILEPTAL (OXCARBAZEPINE) TAB 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000197", "type": "CDM"}, {"code": "62756018418", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRIM NAIL(S)", "code_information": [{"code": "G0127", "type": "HCPCS"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S) ANY NUMBER", "code_information": [{"code": "11719", "type": "CPT"}], "standard_charges": [{"minimum": 209.42, "maximum": 209.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE HCL 250MG", "code_information": [{"code": "Q0173", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIPLE ANTIBIOTIC OINTMENT PKT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200047", "type": "CDM"}, {"code": "47682022335", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRIPTORELIN PAMOATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3315", "type": "HCPCS"}], "standard_charges": [{"minimum": 1601.71, "maximum": 1601.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1601.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRISMUS APPLIANCE", "code_information": [{"code": "D5937", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.19, "maximum": 185.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 185.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST ART", "code_information": [{"code": "37246", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST VEIN", "code_information": [{"code": "37248", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL ART", "code_information": [{"code": "37247", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL VEIN", "code_information": [{"code": "37249", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/O ST", "code_information": [{"code": "66174", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/ST", "code_information": [{"code": "66175", "type": "CPT"}], "standard_charges": [{"minimum": 10755.36, "maximum": 10755.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10755.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ABD AORTA", "code_information": [{"code": "236T", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC BRCHIOCPH", "code_information": [{"code": "237T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ILIAC ART", "code_information": [{"code": "238T", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC RENAL ART", "code_information": [{"code": "234T", "type": "CPT"}], "standard_charges": [{"minimum": 35011.39, "maximum": 35011.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35011.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC VISCERAL", "code_information": [{"code": "235T", "type": "CPT"}], "standard_charges": [{"minimum": 18810.83, "maximum": 18810.83, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 18810.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRML DSTRJ IOS BVN 1ST 2 L/S", "code_information": [{"code": "64628", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRML DSTRJ IOS BVN EA ADDL", "code_information": [{"code": "64629", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV BIL", "code_information": [{"code": "339T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV UNL", "code_information": [{"code": "338T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ DON-DRV CLL-FR DNA", "code_information": [{"code": "118U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ KDN ALGRFT REJ 1494", "code_information": [{"code": "88U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ PD LVR&BWL CD154+CLL", "code_information": [{"code": "81560", "type": "CPT"}], "standard_charges": [{"minimum": 749.65, "maximum": 749.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 749.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ RNL MEAS CD154+CLL", "code_information": [{"code": "18M", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRNSXJ/REPOS ABRRNT RNL VSLS", "code_information": [{"code": "50100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRONOLANE TOPICAL CREAM 1%-5%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001097", "type": "CDM"}, {"code": "11868081402", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 35.67, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TROPONIN I", "code_information": [{"code": "84484", "type": "CPT"}, {"code": "1000211", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.34, "maximum": 52.43, "gross_charge": 58.26, "discounted_cash": 54.17, "estimated_discounted_cash": 59.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 46.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 52.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 33.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRS/REV AF", "code_information": [{"code": "G9929", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRTMNT SIMULATION 3D IMAGE", "code_information": [{"code": "D0393", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRULICITY 1.5MG/0.5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003542", "type": "CDM"}, {"code": "00002143480", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 701.45, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TRURL ABLTJ MAL PRST8 TISS", "code_information": [{"code": "582T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRURL DSTRJ PRST8 TISS RF WV", "code_information": [{"code": "53854", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRUSKIN, PER SQ CENTIMETER", "code_information": [{"code": "Q4167", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRYPSIN", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "1000595", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 21.16, "maximum": 71.98, "gross_charge": 79.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 71.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRYPTASE", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "1000593", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.86, "maximum": 68.98, "gross_charge": 76.65, "discounted_cash": 54.17, "estimated_discounted_cash": 76.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.32, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TSAT", "code_information": [{"code": "84466", "type": "CPT"}, {"code": "1000984", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.67, "maximum": 68.01, "gross_charge": 75.57, "discounted_cash": 54.17, "estimated_discounted_cash": 101.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 60.45, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TSH 3RD GEN SEND OUT", "code_information": [{"code": "84443", "type": "CPT"}, {"code": "1000024", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.32, "maximum": 89.5, "gross_charge": 99.45, "discounted_cash": 54.17, "estimated_discounted_cash": 99.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 79.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 89.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE F-UP OR LMTD", "code_information": [{"code": "93308", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O CONTR, CONT ECG", "code_information": [{"code": "C8930", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CON,STRES", "code_information": [{"code": "C8928", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, COM", "code_information": [{"code": "C8921", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, F/U", "code_information": [{"code": "C8922", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTE W OR WO FOL WCON,DOPPLER", "code_information": [{"code": "C8929", "type": "HCPCS"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTE W/O DOPPLER COMPLETE", "code_information": [{"code": "93307", "type": "CPT"}], "standard_charges": [{"minimum": 1480.98, "maximum": 1480.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1480.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTVI/RPLCMT W/PRSTC VLV PERQ", "code_information": [{"code": "646T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR 1ST PROSTH", "code_information": [{"code": "569T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ EA ADDL PROSTH", "code_information": [{"code": "570T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TUB STOOL OR BENCH", "code_information": [{"code": "E0245", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TUBE BLOOD DARK PURPLE 4ML", "code_information": [{"code": "80000916", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 2.0", "code_information": [{"code": "3001467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 2.5", "code_information": [{"code": "3000603", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 3.0", "code_information": [{"code": "3000605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 3.5", "code_information": [{"code": "3000604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 4.0", "code_information": [{"code": "3000606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 4.0 W/STYLET", "code_information": [{"code": "3001158", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.44, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 4.5", "code_information": [{"code": "3001159", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 5.0", "code_information": [{"code": "3000607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.77, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 5.5", "code_information": [{"code": "3001160", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 6.0", "code_information": [{"code": "3000608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.95, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 6.5", "code_information": [{"code": "3001161", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 7.0", "code_information": [{"code": "3000609", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 7.0 W/STYLET", "code_information": [{"code": "3001165", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.07, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 7.5", "code_information": [{"code": "3000610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.18, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 7.5 W/STYLET", "code_information": [{"code": "3001162", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 10.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 8.0", "code_information": [{"code": "3001164", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 8.0 W/STYLETTE", "code_information": [{"code": "3001163", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 8.5", "code_information": [{"code": "3001261", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.18, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH 9.0", "code_information": [{"code": "3000613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH HOLDER ADULT", "code_information": [{"code": "3000174", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENDOTRACH HOLDER CHILD", "code_information": [{"code": "3001157", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.06, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE ENTERAL FEEDING", "code_information": [{"code": "3000614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE FEED INFANT 8FR", "code_information": [{"code": "3000615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE FEEDING 5FR 15", "code_information": [{"code": "3000617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE FEEDING NASOGRASTIC SUMP 12FR", "code_information": [{"code": "3001443", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE GASTRIC SUMP 14FR", "code_information": [{"code": "3000627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE GASTRIC SUMP 16FR", "code_information": [{"code": "3000628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE GASTRIC SUMP 18FR", "code_information": [{"code": "3000629", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE GASTROSTOMY 20FR W/20CC", "code_information": [{"code": "3000619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE GASTROSTOMY 22FR W/20CC", "code_information": [{"code": "3001385", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE GRASTIC SUMP 10FR", "code_information": [{"code": "3001442", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.89, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC LEVIN TYPE 12FR", "code_information": [{"code": "3000620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC LEVIN TYPE 14FR", "code_information": [{"code": "3000621", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC LEVIN TYPE 16FR", "code_information": [{"code": "3000622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBE NASOGASTRIC LEVIN TYPE 18FR", "code_information": [{"code": "3000623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBERSOL (TUBERCULIN) 0.1ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000294", "type": "CDM"}, {"code": "49281075221", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 70.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBING COILED 60 - RADIOLOGY", "code_information": [{"code": "3001427", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBING SUCT CONN 3/1", "code_information": [{"code": "3000382", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBULAR GAUZE 1 1/2 X50YDS", "code_information": [{"code": "80000896", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBULAR GAUZE 2 5/8 X50YDS", "code_information": [{"code": "80000897", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUBULAR GAUZE 3 5/8 X50YDS", "code_information": [{"code": "80000898", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUMOR CELL DEPLETE OF HARVST", "code_information": [{"code": "38211", "type": "CPT"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TUMOR IMMUNOHISTOCHEM/COMPUT", "code_information": [{"code": "88361", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 129.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 129.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TUMOR IMMUNOHISTOCHEM/MANUAL", "code_information": [{"code": "88360", "type": "CPT"}], "standard_charges": [{"minimum": 92.12, "maximum": 128.92, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 128.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TUMS (CALCIUM CARBONATE) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000470", "type": "CDM"}, {"code": "00536100715", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TUSSIONEX PENNKINETIC 10MG-8MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001423", "type": "CDM"}, {"code": "27808008602", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.52, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TWIST DRILL HOLE", "code_information": [{"code": "61105", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TWN ZYG GEN SEQ ALYS CHRMS2", "code_information": [{"code": "60U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TWO-WAY AUDIO AND VIDEO HHS", "code_information": [{"code": "G0320", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX AMBLYOPIA ASSMT W/REPORT", "code_information": [{"code": "688T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX AMBLYOPIA DEV SETUP 1ST", "code_information": [{"code": "687T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1 CC/<", "code_information": [{"code": "11950", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1.1-5.0CC", "code_information": [{"code": "11951", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 5.1-10CC", "code_information": [{"code": "11952", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS >10.0 CC", "code_information": [{"code": "11954", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX FOR OPIOID USE DEMO PROJ", "code_information": [{"code": "G2172", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX L/R ATRIAL FIB ADDL", "code_information": [{"code": "93657", "type": "CPT"}], "standard_charges": [{"minimum": 52159.66, "maximum": 52159.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 52159.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX PLN MAG FLD ABLTJ PRST8", "code_information": [{"code": "738T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TXMNTS 2 PHYS/QHP BY 1 MON", "code_information": [{"code": "5020F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TYGACIL INJ 50MG", "drug_information": {"unit": 50.0, "type": "EA"}, "code_information": [{"code": "J3243", "type": "HCPCS"}, {"code": "72000458", "type": "CDM"}, {"code": "00008499020", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 102.6, "maximum": 509.24, "gross_charge": 180.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 162.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 102.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYLENOL #3 (APAP/COD) TAB 30MG/300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000168", "type": "CDM"}, {"code": "00406048462", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL #4 (ACETAMINOPHEN/COD 300-60)TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002882", "type": "CDM"}, {"code": "64380044701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL (ACETAMEN) LIQ 5ML 160MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000303", "type": "CDM"}, {"code": "58657052504", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL (ACETAMINOPHEN) SUPP 120MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000001", "type": "CDM"}, {"code": "45802073230", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL (ACETAMINOPHEN) SUPP 325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000002", "type": "CDM"}, {"code": "51672211602", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL (ACETAMINOPHEN) SUPP 650MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000003", "type": "CDM"}, {"code": "45802073030", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL (ACETAMINOPHEN) TAB 325MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000473", "type": "CDM"}, {"code": "50580045811", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL (ACETAMINOPHEN) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000472", "type": "CDM"}, {"code": "00536117201", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL ARTHRITIS ER TAB 650MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000283", "type": "CDM"}, {"code": "50580078324", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL PM TAB 500MG/25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000449", "type": "CDM"}, {"code": "50580060801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLENOL W/COD ELIX 120MG/12MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000004", "type": "CDM"}, {"code": "64950037416", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYLOX (APAP/OXYCOD) CAP 5MG/500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000216", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "TYMP MEMB MOTION EXAMD", "code_information": [{"code": "2035F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TYMPANOMETRY", "code_information": [{"code": "92567", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TYMPANOMETRY & REFLEX THRESH", "code_information": [{"code": "92550", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TYMS GENE COM VARIANTS", "code_information": [{"code": "81346", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 201.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TYPE LOCATION ACTIVITYASSESS", "code_information": [{"code": "1052F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TYPHOID VACCINE IM", "code_information": [{"code": "90691", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TYPHOID VACCINE ORAL", "code_information": [{"code": "90690", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TYROSINEMIA TYP I MNTR QUAN", "code_information": [{"code": "383U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Tacrolimus, granules, oral suspension, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7521", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a Medicare-enrolled opioid treatment program);( List separately in addition to each primary code)", "code_information": [{"code": "G0532", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Tau, phosphorylated (eg, pTau 181, pTau 217), each", "code_information": [{"code": "84393", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Tau, phosphorylated, pTau217", "code_information": [{"code": "479U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Tau, total (tTau)", "code_information": [{"code": "84394", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TheraMend, per square centimeter", "code_information": [{"code": "Q4342", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Therapeutic drug monitoring, 200 or more drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally effective range of prescribed and non-prescribed medications", "code_information": [{"code": "520U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Therapeutic drug monitoring, 80 or more psychoactive drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally and maximally effective dose of prescribed and non-prescribed medications", "code_information": [{"code": "517U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Therapeutic drug monitoring, 90 or more pain and mental health drugs or substances, LC-MS/MS, plasma, qualitative and quantitative therapeutic minimally effective range of prescribed and non-prescribed medications", "code_information": [{"code": "518U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Therapeutic drug monitoring, medications specific to pain, depression, and anxiety, LC-MS/MS, plasma, 110 or more drugs or substances, qualitative and quantitative therapeutic minimally effective range of prescribed, non-prescribed, and illicit medication", "code_information": [{"code": "519U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Therapeutic radiology simulation-aided field setting; complex, including acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling)", "code_information": [{"code": "G0562", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Thoracic fascial plane block, bilateral; by continuous infusion(s), including imaging guidance, when performed", "code_information": [{"code": "64469", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance, when performed", "code_information": [{"code": "64468", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Thoracic fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed", "code_information": [{"code": "64467", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed", "code_information": [{"code": "64466", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Tissue marker, probe detectable any method (implantable), with delivery system", "code_information": [{"code": "C1739", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; initial placement, including mastoidectomy, placement of and attachment to sound processor", "code_information": [{"code": "951T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; removal, including removal of sound processor and all implant components", "code_information": [{"code": "955T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; replacement of sound processor only, with attachment to existing transducers", "code_information": [{"code": "954T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; revision or replacement, with mastoidectomy and replacement of sound processor", "code_information": [{"code": "952T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Totally implantable active middle ear hearing implant; revision or replacement, without mastoidectomy and replacement of sound processor", "code_information": [{"code": "953T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Traditional healing service", "code_information": [{"code": "H0051", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transanal insertion of endoluminal temporary colorectal anastomosis protection device, including vacuum anchoring component and flexible sheath connected to external vacuum source and monitoring system", "code_information": [{"code": "967T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transcatheter implantation of wireless inferior vena cava sensor for long-term hemodynamic monitoring, including deployment of the sensor, radiological supervision and interpretation, right heart catheterization, and inferior vena cava venography, when pe", "code_information": [{"code": "981T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transcatheter implantation of wireless left atrial pressure sensor for long-term left atrial pressure monitoring, including sensor calibration and deployment, right heart catheterization, transseptal puncture, imaging guidance, and radiological supervisio", "code_information": [{"code": "933T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transcut tibial nerv stimula", "code_information": [{"code": "E0736", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transcutaneous electrical nerve stimulator for nerves in the auricular region", "code_information": [{"code": "E0721", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transcutaneous tibial nerve stimulator, controlled by phone application", "code_information": [{"code": "E0737", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to p", "code_information": [{"code": "C7563", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance; prostate volume greater or equal to 50 mL", "code_information": [{"code": "867T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine (allograft rejection, kidney), mRNA, gene expression profiling by quantitative polymerase chain reaction (qPCR) of 139 genes, utilizing whole blood, algorithm reported as a binary categorization as transplant excellence, which ind", "code_information": [{"code": "81558", "type": "CPT"}], "standard_charges": [{"minimum": 3726.0, "maximum": 3726.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3726.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine, quantification of donor-derived cell-free DNA (cfDNA) using next-generation sequencing, plasma, reported as percentage of donor-derived cell-free DNA", "code_information": [{"code": "493U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine, quantification of donor-derived cell-free DNA using 40 single-nucleotide polymorphisms (SNPs), plasma, and urine, initial evaluation reported as percentage of donor-derived cell-free DNA with risk for active rejection", "code_information": [{"code": "508U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine, quantification of donor-derived cell-free DNA using next-generation sequencing analysis of plasma, reported as percentage of donor-derived cell-free DNA to determine probability of rejection", "code_information": [{"code": "540U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Transplantation medicine, quantification of donor-derived cell-free DNA using up to 12 single-nucleotide polymorphisms (SNPs) previously identified, plasma, reported as percentage of donor-derived cell-free DNA with risk for active rejection", "code_information": [{"code": "509U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Tri-Membrane Wrap, per square centimeter", "code_information": [{"code": "Q4344", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Tympanostomy with local or topical anesthesia and insertion of a ventilating tube when performed with tympanostomy tube delivery device, unilateral (List separately in addition to 69433) (Do not use in conjunction with 0583T)", "code_information": [{"code": "G0561", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "U/S TRTMT, NOT LEIOMYOMATA", "code_information": [{"code": "C9734", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "U2AF1 GENE COMMON VARIANTS", "code_information": [{"code": "81357", "type": "CPT"}], "standard_charges": [{"minimum": 222.24, "maximum": 222.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 222.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UCG PREGNANCY TEST", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "1000130", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 8.77, "maximum": 33.69, "gross_charge": 37.44, "discounted_cash": 54.17, "estimated_discounted_cash": 37.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 29.95, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 33.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 21.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UE ENCLOSURE RESTR ROM", "code_information": [{"code": "E0711", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UGT1A1 GENE COMMON VARIANTS", "code_information": [{"code": "81350", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 269.1, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 269.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ULORIC (FEBUXOSTAT) 40MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000825", "type": "CDM"}, {"code": "64764091830", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ULORIC (FEBUXOSTAT) 80MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000676", "type": "CDM"}, {"code": "43547029603", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 32.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ULTRACET (TRAMADOL/ACETAM) TAB 37.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000463", "type": "CDM"}, {"code": "50268077415", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ULTRAFILTRATION MONITOR", "code_information": [{"code": "S9007", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ULTRAM (TRAMADOL) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000462", "type": "CDM"}, {"code": "00904749661", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [{"code": "278", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [{"code": "279", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [{"code": "173", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND BREAST LIMITED", "code_information": [{"code": "76642", "type": "CPT"}], "standard_charges": [{"minimum": 109.01, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 109.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND NOT PERF, RNG", "code_information": [{"code": "G8808", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ULTRAVIOLET LIGHT THERAPY", "code_information": [{"code": "96900", "type": "CPT"}], "standard_charges": [{"minimum": 103.18, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ULTRAVIOLET THERAPY", "code_information": [{"code": "97028", "type": "CPT"}], "standard_charges": [{"minimum": 7.54, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UMBILICAL ARTERY ECHO", "code_information": [{"code": "76820", "type": "CPT"}], "standard_charges": [{"minimum": 58.67, "maximum": 324.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UMBILICAL CORD OCCLUD W/US", "code_information": [{"code": "59072", "type": "CPT"}], "standard_charges": [{"minimum": 3207.04, "maximum": 3207.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3207.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNASYN 1.5 GM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0295", "type": "HCPCS"}, {"code": "7000037", "type": "CDM"}, {"code": "25021018620", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNASYN 1.5GM/100ML NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0295", "type": "HCPCS"}, {"code": "72001077", "type": "CDM"}, {"code": "25021018620", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNASYN 3 GM INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0295", "type": "HCPCS"}, {"code": "72000555", "type": "CDM"}, {"code": "00049001483", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNASYN 3GM/100ML 0.9% NS IVPB", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J0295", "type": "HCPCS"}, {"code": "7000475", "type": "CDM"}, {"code": "67457034910", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 25.65, "maximum": 40.5, "gross_charge": 45.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNCLASSIFIED BIOLOGICS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNCLASSIFIED DRUGS OR BIOLOG", "code_information": [{"code": "C9399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "383", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UNDERPAD FLUFF BLUE 30 X36", "code_information": [{"code": "3001474", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 30.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UNDERPAD FLUFF GREEN 30X30", "code_information": [{"code": "3000159", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 9.62, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UNDERWEAR PROTECTIVE 2XL", "code_information": [{"code": "80000909", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 7.32, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UNDERWEAR PROTECTIVE LGE", "code_information": [{"code": "3001049", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 24.2, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UNDERWEAR PROTECTIVE SM/MED", "code_information": [{"code": "3001256", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UNDERWEAR PROTECTIVE XL", "code_information": [{"code": "3001050", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 24.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UNGROUPABLE", "code_information": [{"code": "999", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UNHLTHY ETOH RCVD COUNS", "code_information": [{"code": "G2200", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNIPUNCTURE CONTROL SYSTEM", "code_information": [{"code": "E1580", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTD NONINVAS VASC DX STD", "code_information": [{"code": "93998", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX HEMIC/LYMPHTC SYS", "code_information": [{"code": "38999", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX SKN MUC MEMB SUBQ", "code_information": [{"code": "17999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED ALL/IMMLG SVC/PX", "code_information": [{"code": "95199", "type": "CPT"}], "standard_charges": [{"minimum": 135.8, "maximum": 135.8, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED AMBULANCE SERVICE", "code_information": [{"code": "A0999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED ANES PROCEDURE", "code_information": [{"code": "1999", "type": "CPT"}], "standard_charges": [{"minimum": 76.29, "maximum": 76.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 76.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMISTRY PROCEDURE", "code_information": [{"code": "84999", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMOTHERAPY PX", "code_information": [{"code": "96549", "type": "CPT"}], "standard_charges": [{"minimum": 966.98, "maximum": 966.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 966.98, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CRANFCL&MAXLFCL PX", "code_information": [{"code": "21299", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CT PROCEDURE", "code_information": [{"code": "76497", "type": "CPT"}], "standard_charges": [{"minimum": 137.4, "maximum": 191.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 137.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 191.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV PX DX NUC MED", "code_information": [{"code": "78499", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV SVC/PROCEDURE", "code_information": [{"code": "93799", "type": "CPT"}], "standard_charges": [{"minimum": 84.11, "maximum": 84.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 84.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOGENETIC STUDY", "code_information": [{"code": "88299", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOPATHOLOGY PX", "code_information": [{"code": "88199", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED DIALYSIS PROCEDURE", "code_information": [{"code": "90999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX GI PROCEDURE", "code_information": [{"code": "91299", "type": "CPT"}], "standard_charges": [{"minimum": 2146.04, "maximum": 2146.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX RADIOGRAPHIC PX", "code_information": [{"code": "76499", "type": "CPT"}], "standard_charges": [{"minimum": 182.71, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED E&M SERVICE", "code_information": [{"code": "99499", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED ENDOCRINE PX DX NUC", "code_information": [{"code": "78099", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED FETAL INVAS PX W/US", "code_information": [{"code": "59897", "type": "CPT"}], "standard_charges": [{"minimum": 588.01, "maximum": 588.01, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 588.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED FLUOROSCOPIC PX", "code_information": [{"code": "76496", "type": "CPT"}], "standard_charges": [{"minimum": 80.44, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 80.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED GI PX DX NUC MED", "code_information": [{"code": "78299", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED GU PX DX NUC MED", "code_information": [{"code": "78799", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED HEMATOLOGY&COAGJ PX", "code_information": [{"code": "85999", "type": "CPT"}], "standard_charges": [{"minimum": 17.93, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED HOME VISIT SVC/PX", "code_information": [{"code": "99600", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED HYSTSC PX UTERUS", "code_information": [{"code": "58579", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED IMMUNE GLOBULIN", "code_information": [{"code": "90399", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED IN VIVO LAB SERVICE", "code_information": [{"code": "88749", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX APPENDIX", "code_information": [{"code": "44979", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BILIARY TRC", "code_information": [{"code": "47579", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BLADDER", "code_information": [{"code": "51999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ENDOC SYS", "code_information": [{"code": "60659", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ESOPH", "code_information": [{"code": "43289", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX INTESTINE", "code_information": [{"code": "44238", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LIVER", "code_information": [{"code": "47379", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LYMPHTC SYS", "code_information": [{"code": "38589", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX OVIDCT OVRY", "code_information": [{"code": "58679", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX RENAL", "code_information": [{"code": "50549", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX SPLEEN", "code_information": [{"code": "38129", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX STOMACH", "code_information": [{"code": "43659", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX TESTIS", "code_information": [{"code": "54699", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX URETER", "code_information": [{"code": "50949", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX UTERUS", "code_information": [{"code": "58578", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAAA", "code_information": [{"code": "81599", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAXLFCL PROSTH PX", "code_information": [{"code": "21089", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MICROBIOLOGY PX", "code_information": [{"code": "87999", "type": "CPT"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PATH TEST", "code_information": [{"code": "89240", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PROSTHETIC SER", "code_information": [{"code": "L8499", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PX DX NUC MED", "code_information": [{"code": "78999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MODALITY", "code_information": [{"code": "97039", "type": "CPT"}], "standard_charges": [{"minimum": 11.91, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.91, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MOLECULAR PATHOLOGY", "code_information": [{"code": "81479", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MR PROCEDURE", "code_information": [{"code": "76498", "type": "CPT"}], "standard_charges": [{"minimum": 128.9, "maximum": 128.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 128.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX DX NUC", "code_information": [{"code": "78399", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX HEAD", "code_information": [{"code": "21499", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED NECROPSY (AUTOPSY)", "code_information": [{"code": "88099", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED NEUROLOGICAL DX PX", "code_information": [{"code": "95999", "type": "CPT"}], "standard_charges": [{"minimum": 1019.43, "maximum": 1019.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1019.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED NRVS SYS PX DX NUC", "code_information": [{"code": "78699", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED OPH SVC/PROCEDURE", "code_information": [{"code": "92499", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED ORL SERVICE/PX", "code_information": [{"code": "92700", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PHYSCL MED/REHAB PX", "code_information": [{"code": "97799", "type": "CPT"}], "standard_charges": [{"minimum": 763.85, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PREVENTIVE SERVICE", "code_information": [{"code": "99429", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE BREAST", "code_information": [{"code": "19499", "type": "CPT"}], "standard_charges": [{"minimum": 4465.44, "maximum": 4465.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4465.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE COLON", "code_information": [{"code": "45399", "type": "CPT"}], "standard_charges": [{"minimum": 3098.52, "maximum": 3098.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3098.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ESOPHAGUS", "code_information": [{"code": "43499", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE EYELIDS", "code_information": [{"code": "67999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LARYNX", "code_information": [{"code": "31599", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIPS", "code_information": [{"code": "40799", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIVER", "code_information": [{"code": "47399", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE NOSE", "code_information": [{"code": "30999", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ORBIT", "code_information": [{"code": "67599", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE PANCREAS", "code_information": [{"code": "48999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE RECTUM", "code_information": [{"code": "45999", "type": "CPT"}], "standard_charges": [{"minimum": 4701.37, "maximum": 4701.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4701.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE SHOULDER", "code_information": [{"code": "23929", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE SPINE", "code_information": [{"code": "22899", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE STOMACH", "code_information": [{"code": "43999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PSYC SVC/THERAPY", "code_information": [{"code": "90899", "type": "CPT"}], "standard_charges": [{"minimum": 386.79, "maximum": 386.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 386.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PULMONARY SVC/PX", "code_information": [{"code": "94799", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABD PERTM&OMN", "code_information": [{"code": "49999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABDOMEN MUSCSKEL", "code_information": [{"code": "22999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ACCESSORY SINUS", "code_information": [{"code": "31299", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ANT SEGMENT EYE", "code_information": [{"code": "66999", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ARTHROSCOPY", "code_information": [{"code": "29999", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX BILIARY TRACT", "code_information": [{"code": "47999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CARDIAC SURGERY", "code_information": [{"code": "33999", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CASTING/STRPG", "code_information": [{"code": "29799", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CLIN BRACHYTX", "code_information": [{"code": "77799", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CONJUNCTIVA", "code_information": [{"code": "68399", "type": "CPT"}], "standard_charges": [{"minimum": 2934.11, "maximum": 2934.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2934.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DENTALVLR STRUX", "code_information": [{"code": "41899", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DIAPHRAGM", "code_information": [{"code": "39599", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ENDOCRINE SYSTEM", "code_information": [{"code": "60699", "type": "CPT"}], "standard_charges": [{"minimum": 9225.18, "maximum": 9225.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9225.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXC PRESSURE ULC", "code_information": [{"code": "15999", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTERNAL EAR", "code_information": [{"code": "69399", "type": "CPT"}], "standard_charges": [{"minimum": 462.32, "maximum": 462.32, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 462.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTRAOCULAR MUSC", "code_information": [{"code": "67399", "type": "CPT"}], "standard_charges": [{"minimum": 7004.38, "maximum": 7004.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FEMUR/KNEE", "code_information": [{"code": "27599", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FML GENITAL SYS", "code_information": [{"code": "58999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOOT/TOES", "code_information": [{"code": "28899", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOREARM/WRIST", "code_information": [{"code": "25999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HANDS/FINGERS", "code_information": [{"code": "26989", "type": "CPT"}], "standard_charges": [{"minimum": 1417.85, "maximum": 1417.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1417.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HUMERUS/ELBOW", "code_information": [{"code": "24999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX INNER EAR", "code_information": [{"code": "69949", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LACRIMAL SYSTEM", "code_information": [{"code": "68899", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LEG/ANKLE", "code_information": [{"code": "27899", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LUNGS & PLEURA", "code_information": [{"code": "32999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MALE GENITAL SYS", "code_information": [{"code": "55899", "type": "CPT"}], "standard_charges": [{"minimum": 6571.24, "maximum": 6571.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6571.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MAT CARE&DLVR", "code_information": [{"code": "59899", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MECKEL'S DVRTCLM", "code_information": [{"code": "44899", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MED RADJ PHYSICS", "code_information": [{"code": "77399", "type": "CPT"}], "standard_charges": [{"minimum": 1008.55, "maximum": 1008.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MEDIASTINUM", "code_information": [{"code": "39499", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MIDDLE EAR", "code_information": [{"code": "69799", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MUSCSKEL GENERAL", "code_information": [{"code": "20999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NECK/THORAX", "code_information": [{"code": "21899", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NERVOUS SYSTEM", "code_information": [{"code": "64999", "type": "CPT"}], "standard_charges": [{"minimum": 1389.43, "maximum": 1389.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1389.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PALATE UVULA", "code_information": [{"code": "42299", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PELVIS/HIP JOINT", "code_information": [{"code": "27299", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PHRNX ADND/TNSL", "code_information": [{"code": "42999", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX POSTERIOR SEGMNT", "code_information": [{"code": "67299", "type": "CPT"}], "standard_charges": [{"minimum": 3457.65, "maximum": 3457.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3457.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SALIVRY GLND/DUX", "code_information": [{"code": "42699", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SMALL INTESTINE", "code_information": [{"code": "44799", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TEMPORAL BONE", "code_information": [{"code": "69979", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX MGMT", "code_information": [{"code": "77499", "type": "CPT"}], "standard_charges": [{"minimum": 1008.55, "maximum": 1008.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1008.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX PLNG", "code_information": [{"code": "77299", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TONGUE FLR MOUTH", "code_information": [{"code": "41599", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TRACHEA BRONCHI", "code_information": [{"code": "31899", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX URINARY SYSTEM", "code_information": [{"code": "53899", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR NJX", "code_information": [{"code": "36299", "type": "CPT"}], "standard_charges": [{"minimum": 1806.55, "maximum": 1806.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1806.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR SURGERY", "code_information": [{"code": "37799", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VESTIBULE MOUTH", "code_information": [{"code": "40899", "type": "CPT"}], "standard_charges": [{"minimum": 2932.02, "maximum": 2932.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2932.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED REPROD MED LAB PROC", "code_information": [{"code": "89398", "type": "CPT"}], "standard_charges": [{"minimum": 629.58, "maximum": 629.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 629.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED RESP PX DX NUC MED", "code_information": [{"code": "78599", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPEC DERM SVC/PX", "code_information": [{"code": "96999", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPECIAL SVC PX/RPRT", "code_information": [{"code": "99199", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED SURGICAL PATH PX", "code_information": [{"code": "88399", "type": "CPT"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED THERAPEUTIC PX", "code_information": [{"code": "97139", "type": "CPT"}], "standard_charges": [{"minimum": 16.29, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED TRANSFUSION MED PX", "code_information": [{"code": "86999", "type": "CPT"}], "standard_charges": [{"minimum": 83.54, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED URINALYSIS PX", "code_information": [{"code": "81099", "type": "CPT"}], "standard_charges": [{"minimum": 8.77, "maximum": 8.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED VACCINE/TOXOID", "code_information": [{"code": "90749", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED VASC ENDOSCOPY PX", "code_information": [{"code": "37501", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLSTD HEMATOP RET/ENDO LYMP", "code_information": [{"code": "78199", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX ABD PERTM&OMN", "code_information": [{"code": "49329", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX HRNAP HRNRPHY", "code_information": [{"code": "49659", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX MAT CARE&DLVR", "code_information": [{"code": "59898", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX SPRMATIC CORD", "code_information": [{"code": "55559", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNNA BOOT", "code_information": [{"code": "3000385", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 14.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UNPL RET OR W/COMPL W/IN 30D", "code_information": [{"code": "G9308", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNPLND HOSP READM IN 30D", "code_information": [{"code": "G9310", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSCHED DIALYSIS ESRD PT HOS", "code_information": [{"code": "G0257", "type": "HCPCS"}], "standard_charges": [{"minimum": 2442.42, "maximum": 2442.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2442.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSCHEDULED DRESSING CHANGE", "code_information": [{"code": "D4920", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSKILLED RESPITE CARE /15M", "code_information": [{"code": "S5150", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSKILLED RESPITECARE /DIEM", "code_information": [{"code": "S5151", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSPEC MAXILLOFACIAL PROSTH", "code_information": [{"code": "L8048", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED DIAGNOSTIC PROCE", "code_information": [{"code": "D0999", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.54, "maximum": 338.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 338.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED ORAL ANTI-EMETIC", "code_information": [{"code": "Q0181", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED PERIODONTAL PROC", "code_information": [{"code": "D4999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3398.15, "maximum": 3398.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3398.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED PREVENTIVE PROC", "code_information": [{"code": "D1999", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.51, "maximum": 355.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 355.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNUSUAL PHYSICIAN TRAVEL", "code_information": [{"code": "99082", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNXPL CNST HRTBL DO GN XPRSN", "code_information": [{"code": "266U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPGRADE OF PACEMAKER SYSTEM", "code_information": [{"code": "33214", "type": "CPT"}], "standard_charges": [{"minimum": 26487.51, "maximum": 26487.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 26487.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY PROSTHES NOS", "code_information": [{"code": "L7499", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPPER GI ENDO NOT BARRTTS", "code_information": [{"code": "3141F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPPER GI ENDO SHOWS BARRTTS", "code_information": [{"code": "3140F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPPER GI ENDOSCOPY PERFORMED", "code_information": [{"code": "3130F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [{"code": "256", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "255", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "257", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB ORTHOSIS NOS", "code_information": [{"code": "L3999", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPPR GI SCOPE W/SUBMUC INJ", "code_information": [{"code": "43236", "type": "CPT"}], "standard_charges": [{"minimum": 6615.87, "maximum": 6615.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6615.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPR/L XTREMITY ART 2 LEVELS", "code_information": [{"code": "93922", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPR/LXTR ART STDY 3+ LVLS", "code_information": [{"code": "93923", "type": "CPT"}], "standard_charges": [{"minimum": 218.0, "maximum": 218.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 218.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UPRIGHT GAIT TRAINER", "code_information": [{"code": "E8001", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UR ALBUMIN SEMIQUANTITATIVE", "code_information": [{"code": "82044", "type": "CPT"}], "standard_charges": [{"minimum": 7.16, "maximum": 8.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URASAL (NF-METHENAMINE MANDELATE) 1000MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001782", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URE-NA (UREA) 15GM POWDER PACKET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004311", "type": "CDM"}, {"code": "62530000011", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.81, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UREA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3350", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN 24 HR URINE", "code_information": [{"code": "84540", "type": "CPT"}, {"code": "1000214", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.39, "maximum": 25.29, "gross_charge": 28.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 22.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN SEMI-QUANT", "code_information": [{"code": "84525", "type": "CPT"}], "standard_charges": [{"minimum": 5.9, "maximum": 5.9, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URECHOLINE (BETHANECHOL) 25MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001919", "type": "CDM"}, {"code": "00832051201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URECHOLINE (BETHANECHOL) 50MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003173", "type": "CDM"}, {"code": "51293064801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY", "code_information": [{"code": "50970", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50955", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50974", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & CATHETER", "code_information": [{"code": "50972", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50957", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50961", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50976", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50980", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETERAL EMBOLIZATION/OCCL", "code_information": [{"code": "50705", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETERAL REFLUX STUDY", "code_information": [{"code": "78740", "type": "CPT"}], "standard_charges": [{"minimum": 259.03, "maximum": 259.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 259.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "671", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "672", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "URETHRAL STRICTURE", "code_information": [{"code": "697", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "URETHRLYS TRANSVAG W/ SCOPE", "code_information": [{"code": "53500", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URGENT CARE CENTER GLOBAL", "code_information": [{"code": "S9083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URGENT CARE SS", "code_information": [{"code": "G4036", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URGENT SURGERY", "code_information": [{"code": "G9752", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URI EP COMPETE DIAG", "code_information": [{"code": "G8709", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URI NEW RX ANTIBIOTIC 30D", "code_information": [{"code": "G2174", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URI W COMORB 12M OTH DX", "code_information": [{"code": "G2173", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URIBEL (NF-Uribel) Oral Capsule", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002482", "type": "CDM"}, {"code": "00076011101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URIC ACID", "code_information": [{"code": "84550", "type": "CPT"}, {"code": "1000215", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.2, "maximum": 24.05, "gross_charge": 26.73, "discounted_cash": 54.17, "estimated_discounted_cash": 26.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 21.38, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 15.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URIC ACID-24 HR URINE", "code_information": [{"code": "84560", "type": "CPT"}, {"code": "1000694", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.84, "maximum": 25.29, "gross_charge": 28.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 22.48, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINAL FEMALE DISP", "code_information": [{"code": "3000386", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINAL MALE DISP", "code_information": [{"code": "3000387", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINALYSIS", "code_information": [{"code": "81000", "type": "CPT"}, {"code": "1099005", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.62, "maximum": 24.3, "gross_charge": 27.0, "discounted_cash": 54.17, "estimated_discounted_cash": 27.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 15.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS", "code_information": [{"code": "81005", "type": "CPT"}], "standard_charges": [{"minimum": 2.5, "maximum": 8.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINALYSIS (CHG)", "code_information": [{"code": "81000", "type": "CPT"}, {"code": "1000103", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 4.62, "maximum": 16.87, "gross_charge": 18.75, "discounted_cash": 54.17, "estimated_discounted_cash": 27.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS AUTO W/O SCOPE", "code_information": [{"code": "81003", "type": "CPT"}], "standard_charges": [{"minimum": 2.59, "maximum": 2.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINALYSIS AUTO W/SCOPE", "code_information": [{"code": "81001", "type": "CPT"}], "standard_charges": [{"minimum": 3.65, "maximum": 8.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINALYSIS GLASS TEST", "code_information": [{"code": "81020", "type": "CPT"}], "standard_charges": [{"minimum": 5.41, "maximum": 8.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINALYSIS NONAUTO W/O SCOPE", "code_information": [{"code": "81002", "type": "CPT"}], "standard_charges": [{"minimum": 4.0, "maximum": 4.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINALYSIS VOLUME MEASURE", "code_information": [{"code": "81050", "type": "CPT"}], "standard_charges": [{"minimum": 4.19, "maximum": 8.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINARY BLADDER RETENTION", "code_information": [{"code": "78730", "type": "CPT"}], "standard_charges": [{"minimum": 89.58, "maximum": 89.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 89.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINARY EXTENSION TUBING 0.335 X18", "code_information": [{"code": "3001471", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINARY EXTENSION TUBING 5/16 X18", "code_information": [{"code": "3001472", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.49, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINARY REFLEX STUDY", "code_information": [{"code": "51792", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITH MCC", "code_information": [{"code": "693", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITHOUT MCC", "code_information": [{"code": "694", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "URINE BACTERIA CULTURE", "code_information": [{"code": "87088", "type": "CPT"}], "standard_charges": [{"minimum": 9.3, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE C and S-REF LAB", "code_information": [{"code": "87086", "type": "CPT"}, {"code": "1000682", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.28, "maximum": 43.01, "gross_charge": 47.79, "discounted_cash": 54.17, "estimated_discounted_cash": 47.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 38.23, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 43.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 27.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE COLL PED.UNSTER", "code_information": [{"code": "3000390", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINE COLLECTOR PEDIATRIC STER", "code_information": [{"code": "3000388", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINE CONTAINER 24HR", "code_information": [{"code": "3000389", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 4.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINE CONTAINER STERILE", "code_information": [{"code": "3000630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINE CONTAINER TRI-POUR", "code_information": [{"code": "3000391", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "URINE CYTOLOGY", "code_information": [{"code": "88112", "type": "CPT"}, {"code": "1000135", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 92.12, "gross_charge": 98.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 71.44, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 78.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 92.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 88.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE DRUG SCREEN", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "1000157", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.49, "maximum": 77.46, "gross_charge": 86.07, "discounted_cash": 54.17, "estimated_discounted_cash": 104.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 68.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 77.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 49.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE FLOW MEASUREMENT", "code_information": [{"code": "51736", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE INCON CHARACTERIZED", "code_information": [{"code": "1091F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE INCON PLAN DOCD", "code_information": [{"code": "509F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE REAGENT STRIPS/TABLETS", "code_information": [{"code": "A4250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE SCREEN FOR BACTERIA", "code_information": [{"code": "81007", "type": "CPT"}], "standard_charges": [{"minimum": 8.77, "maximum": 34.48, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE SHUNT TO INTESTINE", "code_information": [{"code": "50815", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE SPECIMEN COLLECT MULT", "code_information": [{"code": "P9615", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROBILINOGEN", "code_information": [{"code": "84583", "type": "CPT"}, {"code": "1000043", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.96, "maximum": 26.78, "gross_charge": 29.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROFOLLITROPIN, 75 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3355", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.24, "maximum": 509.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 509.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY ANTEGRADE RS&I", "code_information": [{"code": "74425", "type": "CPT"}], "standard_charges": [{"minimum": 175.3, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 175.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BLS W/NF", "code_information": [{"code": "74415", "type": "CPT"}], "standard_charges": [{"minimum": 198.42, "maximum": 198.42, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 198.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BOLUS", "code_information": [{"code": "74410", "type": "CPT"}], "standard_charges": [{"minimum": 179.76, "maximum": 179.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 179.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY RTRGR +-KUB", "code_information": [{"code": "74420", "type": "CPT"}], "standard_charges": [{"minimum": 97.77, "maximum": 97.77, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 97.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROKINASE 250,000 IU INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3365", "type": "HCPCS"}], "standard_charges": [{"minimum": 1683.72, "maximum": 1683.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1683.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROKINASE 5000 IU INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3364", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROLOGY SS", "code_information": [{"code": "G4037", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROSTOMY DRAIN TUBE ADAPTER", "code_information": [{"code": "3001246", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "UROSTOMY POUCH 2PC/ 3904", "code_information": [{"code": "3001237", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 12.98, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "US ABDL AORTA SCREEN AAA", "code_information": [{"code": "76706", "type": "CPT"}], "standard_charges": [{"minimum": 136.12, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 136.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US ABDOMEN COMPLETE", "code_information": [{"code": "76700", "type": "CPT"}, {"code": "2600004", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 150.76, "maximum": 500.06, "gross_charge": 555.63, "discounted_cash": 54.17, "estimated_discounted_cash": 555.63, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 150.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 444.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 500.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 316.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDOMEN LIMITED RUQ", "code_information": [{"code": "76705", "type": "CPT"}, {"code": "2600001", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 112.69, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 112.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDOMEN LIMITED SINGLE ORGAN", "code_information": [{"code": "76705", "type": "CPT"}, {"code": "2600002", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 112.69, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 112.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDOMEN LUQ", "code_information": [{"code": "76775", "type": "CPT"}, {"code": "2600003", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 74.88, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDOMINAL AORTA", "code_information": [{"code": "76775", "type": "CPT"}, {"code": "2600029", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 74.88, "maximum": 353.03, "gross_charge": 343.08, "discounted_cash": 54.17, "estimated_discounted_cash": 343.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.46, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 308.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ASPIRATION", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "2600005", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 74.94, "maximum": 500.06, "gross_charge": 555.63, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 444.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 500.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 316.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BONE DENSITY MEASURE", "code_information": [{"code": "76977", "type": "CPT"}], "standard_charges": [{"minimum": 9.0, "maximum": 9.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US BONE STIMULATION", "code_information": [{"code": "20979", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US BREAST BILATERAL", "code_information": [{"code": "2600007", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"gross_charge": 394.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "US BREAST LEFT", "code_information": [{"code": "2600031", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"gross_charge": 343.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "US BREAST RIGHT", "code_information": [{"code": "2600030", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"gross_charge": 343.08, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "US BREAST UNILATERAL", "code_information": [{"code": "76641", "type": "CPT"}, {"code": "2600008", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 132.5, "maximum": 353.03, "gross_charge": 290.07, "discounted_cash": 54.17, "estimated_discounted_cash": 320.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 132.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 261.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 165.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ELASTOGRAPHY", "code_information": [{"code": "76981", "type": "CPT"}, {"code": "2600037", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 133.02, "maximum": 281.25, "gross_charge": 312.51, "discounted_cash": 54.17, "estimated_discounted_cash": 312.51, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 133.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 250.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 281.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 178.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ELASTOGRAPHY 1ST LESION", "code_information": [{"code": "76982", "type": "CPT"}, {"code": "2600038", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 120.15, "maximum": 253.15, "gross_charge": 281.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 225.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 253.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 160.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ELASTOGRAPHY ADDITIONAL LESION", "code_information": [{"code": "76983", "type": "CPT"}, {"code": "2600039", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 78.58, "maximum": 166.05, "gross_charge": 184.5, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 147.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 105.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDO BACK WALL COMP", "code_information": [{"code": "76770", "type": "CPT"}], "standard_charges": [{"minimum": 139.61, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 139.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US EXAM CHEST", "code_information": [{"code": "76604", "type": "CPT"}], "standard_charges": [{"minimum": 75.35, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 75.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS DYNAMIC", "code_information": [{"code": "76885", "type": "CPT"}], "standard_charges": [{"minimum": 146.68, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 146.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS STATIC", "code_information": [{"code": "76886", "type": "CPT"}], "standard_charges": [{"minimum": 129.02, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 129.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US EXTREMITY NON VASCULAR", "code_information": [{"code": "76881", "type": "CPT"}, {"code": "2600026", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 75.53, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 75.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDANCE FETAL REDUCT", "code_information": [{"code": "S8055", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.23, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US GUIDE INTRAOP", "code_information": [{"code": "76998", "type": "CPT"}], "standard_charges": [{"minimum": 81.69, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 81.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US GUIDE TISSUE ABLATION", "code_information": [{"code": "76940", "type": "CPT"}], "standard_charges": [{"minimum": 207.22, "maximum": 361.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 207.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US GUIDED CARPAL TUNNEL", "code_information": [{"code": "20611", "type": "CPT"}, {"code": "2600036", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 98.23, "maximum": 767.67, "gross_charge": 172.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 129.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 137.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 155.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 98.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDED CYST ASPIRATION", "code_information": [{"code": "20611", "type": "CPT"}, {"code": "2600034", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 107.17, "maximum": 767.67, "gross_charge": 188.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 141.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 150.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 169.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 107.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDED JOINT EFFUSION", "code_information": [{"code": "20611", "type": "CPT"}, {"code": "2600035", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 187.25, "maximum": 767.67, "gross_charge": 328.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 246.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 262.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 295.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 187.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDED JOINT INJECTION MAJOR", "code_information": [{"code": "20611", "type": "CPT"}, {"code": "2600033", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 187.25, "maximum": 767.67, "gross_charge": 328.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 246.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 262.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 767.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 295.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 187.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US LEIOMYOMATA ABLATE <200", "code_information": [{"code": "71T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US LMTD JT/FCL EVL NVASC XTR", "code_information": [{"code": "76882", "type": "CPT"}], "standard_charges": [{"minimum": 71.89, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US NRV&ACC STRUX 1XTR COMPRE", "code_information": [{"code": "76883", "type": "CPT"}], "standard_charges": [{"minimum": 94.07, "maximum": 94.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US OB 1st TRIMESTER", "code_information": [{"code": "76801", "type": "CPT"}, {"code": "2600010", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 151.29, "maximum": 363.6, "gross_charge": 404.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 151.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 323.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 363.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 230.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB BIOPHYSICAL PROFILE", "code_information": [{"code": "76819", "type": "CPT"}, {"code": "2600006", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 107.82, "maximum": 363.6, "gross_charge": 404.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 107.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 323.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 363.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 230.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB LIMITED", "code_information": [{"code": "76815", "type": "CPT"}, {"code": "2600009", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 104.7, "maximum": 363.6, "gross_charge": 404.0, "discounted_cash": 54.17, "estimated_discounted_cash": 404.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 104.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 323.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 363.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 230.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB SCREENING COMPLETE", "code_information": [{"code": "76805", "type": "CPT"}, {"code": "2600011", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 173.28, "maximum": 363.6, "gross_charge": 404.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 173.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 323.2, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 324.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 363.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 230.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US PARACENTESIS GUIDED", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "2600012", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 74.94, "maximum": 361.71, "gross_charge": 401.91, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 321.52, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 361.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 229.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US PELVIC LIMITED (BLADDER or APPENDIX)", "code_information": [{"code": "76857", "type": "CPT"}, {"code": "2600013", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 61.57, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 61.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US PELVIS TRANSABD (NON OB)", "code_information": [{"code": "76856", "type": "CPT"}, {"code": "2600014", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 136.03, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 136.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US PICC LINE GUIDED", "code_information": [{"code": "76937", "type": "CPT"}, {"code": "2600016", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 50.14, "maximum": 361.23, "gross_charge": 97.98, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 78.38, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 88.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US PROSTATE", "code_information": [{"code": "76873", "type": "CPT"}, {"code": "2600017", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 223.1, "maximum": 417.79, "gross_charge": 464.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 223.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 371.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 417.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 264.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US PYLORUS (PEDIATRIC RUQ)", "code_information": [{"code": "76775", "type": "CPT"}, {"code": "2600018", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 74.88, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US REMS B1 DNS HIPS PLVS/SPI", "code_information": [{"code": "815T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US RENAL", "code_information": [{"code": "76775", "type": "CPT"}, {"code": "2600019", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 74.88, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.88, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US SCROTUM", "code_information": [{"code": "76870", "type": "CPT"}, {"code": "2600021", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 129.54, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 129.54, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US SPINE", "code_information": [{"code": "76800", "type": "CPT"}, {"code": "2600040", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 187.9, "maximum": 617.11, "gross_charge": 685.68, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 187.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 548.54, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 617.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 390.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US SUPERFICAL STRUCTURES", "code_information": [{"code": "76536", "type": "CPT"}, {"code": "2600022", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 142.81, "maximum": 500.06, "gross_charge": 555.63, "discounted_cash": 54.17, "estimated_discounted_cash": 486.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 142.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 444.5, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 500.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 316.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US THORACENTESIS GUIDED", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "2600023", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 74.94, "maximum": 960.93, "gross_charge": 1067.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 854.16, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 361.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 960.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 608.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US THYROID", "code_information": [{"code": "76536", "type": "CPT"}, {"code": "2600024", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 142.81, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 486.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 142.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRANSPLANTED KIDNEY", "code_information": [{"code": "76776", "type": "CPT"}, {"code": "2600025", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 190.34, "maximum": 353.03, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 190.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRANSRECTAL", "code_information": [{"code": "76872", "type": "CPT"}], "standard_charges": [{"minimum": 176.24, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 176.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US TRANSVAGINAL", "code_information": [{"code": "76830", "type": "CPT"}, {"code": "2600032", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 153.45, "maximum": 353.03, "gross_charge": 343.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 153.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.46, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 308.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB 1ST LES", "code_information": [{"code": "76978", "type": "CPT"}], "standard_charges": [{"minimum": 379.53, "maximum": 379.53, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 379.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB EA ADDL", "code_information": [{"code": "76979", "type": "CPT"}], "standard_charges": [{"minimum": 250.12, "maximum": 250.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 250.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "US URINE CAPACITY MEASURE", "code_information": [{"code": "51798", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "USE OF SPEECH DEVICE SERVICE", "code_information": [{"code": "92609", "type": "CPT"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "USTEKINUMAB SUB CU INJ, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3357", "type": "HCPCS"}], "standard_charges": [{"minimum": 25343.35, "maximum": 25343.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 25343.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "USTEKINUMAB, IV INJECT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3358", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC", "code_information": [{"code": "742", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "743", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC", "code_information": [{"code": "740", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC", "code_information": [{"code": "739", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "741", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC", "code_information": [{"code": "737", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [{"code": "736", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "738", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "UTILITY SERVICES WAIVER", "code_information": [{"code": "T2035", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Upper extremity addition, external frame, partial hand including fingers", "code_information": [{"code": "L6030", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement", "code_information": [{"code": "L6700", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Upper extremity addition, test socket/interface, partial hand including fingers", "code_information": [{"code": "L6029", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Upper extremity rehab", "code_information": [{"code": "E0738", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Upper gastrointestinal blood detection, sensor capsule, with interpretation and report", "code_information": [{"code": "977T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "V-BAND GASTROPLASTY", "code_information": [{"code": "43842", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "V-VAC STARTER KIT", "code_information": [{"code": "3001200", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VA WHOLE HEALTH PARTNER SERV", "code_information": [{"code": "Q9004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VABRA ASPIRATOR", "code_information": [{"code": "A4480", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAC ADMIN HUMAN PAP DOSE 1", "code_information": [{"code": "D1781", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAC ADMIN HUMAN PAP DOSE 2", "code_information": [{"code": "D1782", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAC ADMIN HUMAN PAP DOSE 3", "code_information": [{"code": "D1783", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VACC AIIV4 NO PRSRV 0.5ML IM", "code_information": [{"code": "90694", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VACC IIV4 NO PRSRV 0.25ML IM", "code_information": [{"code": "90689", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VACCINA IG IM", "code_information": [{"code": "90393", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VACCINIA VRS VAC 0.3 ML PERQ", "code_information": [{"code": "90622", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAG HYST COMPLEX", "code_information": [{"code": "58290", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCL T/O COMPLEX", "code_information": [{"code": "58291", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCLUDING T/O", "code_information": [{"code": "58262", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAG HYST T/O & REPAIR COMPL", "code_information": [{"code": "58292", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE COMPL", "code_information": [{"code": "58294", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE REPAIR", "code_information": [{"code": "58270", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/T/O & VAG REPAIR", "code_information": [{"code": "58263", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/URINARY REPAIR", "code_information": [{"code": "58267", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC", "code_information": [{"code": "746", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "747", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C", "code_information": [{"code": "768", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC", "code_information": [{"code": "797", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC", "code_information": [{"code": "796", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC", "code_information": [{"code": "798", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [{"code": "806", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [{"code": "805", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC", "code_information": [{"code": "807", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY", "code_information": [{"code": "58260", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAGINAL IRRIGATION SET", "code_information": [{"code": "3000393", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VAGINECTOMY PARTIAL W/NODES", "code_information": [{"code": "57109", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43640", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43641", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALIUM (DIAZEPAM) 10MG INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J3360", "type": "HCPCS"}, {"code": "7000148", "type": "CDM"}, {"code": "00409127332", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.7, "maximum": 9.0, "gross_charge": 10.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALIUM (DIAZEPAM) 10MG/2ML INJ SYR.", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J3360", "type": "HCPCS"}, {"code": "72001071", "type": "CDM"}, {"code": "00641624410", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 29.32, "maximum": 46.3, "gross_charge": 51.45, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 41.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 46.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 29.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALIUM (DIAZEPAM) TAB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000149", "type": "CDM"}, {"code": "51079028420", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VALIUM (DIAZEPAM) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000150", "type": "CDM"}, {"code": "00172392660", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VALIUM - DIAZEPAM", "code_information": [{"code": "80346", "type": "CPT"}, {"code": "1000600", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 102.04, "gross_charge": 109.47, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 87.57, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 98.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 62.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALPROIC ACID", "code_information": [{"code": "80164", "type": "CPT"}, {"code": "1000218", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.57, "maximum": 72.17, "gross_charge": 80.19, "discounted_cash": 54.17, "estimated_discounted_cash": 80.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.15, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALRUBICIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9357", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALUE IN PRIMARY CARE MVP", "code_information": [{"code": "M0005", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33390", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33391", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33463", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33464", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VANCOCIN (VANCOMYCIN HCL) CAP 125MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001913", "type": "CDM"}, {"code": "23155085825", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.76, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 1GM INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J3374", "type": "HCPCS"}, {"code": "7000477", "type": "CDM"}, {"code": "70436002182", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 32.91, "maximum": 51.97, "gross_charge": 57.75, "discounted_cash": 54.17, "estimated_discounted_cash": 57.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 51.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 1GM/250ML 0.9% NS IVPB", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J3374", "type": "HCPCS"}, {"code": "72000801", "type": "CDM"}, {"code": "70436002182", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 32.91, "maximum": 51.97, "gross_charge": 57.75, "discounted_cash": 54.17, "estimated_discounted_cash": 57.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 51.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 500MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3370", "type": "HCPCS"}, {"code": "72000586", "type": "CDM"}, {"code": "00409433201", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "estimated_discounted_cash": 57.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 500MG/250ML 0.9% NS IVPB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3370", "type": "HCPCS"}, {"code": "72000709", "type": "CDM"}, {"code": "00409433201", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "estimated_discounted_cash": 57.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 750MG/250ML 0.9% NS IVPB", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J3370", "type": "HCPCS"}, {"code": "72000710", "type": "CDM"}, {"code": "70436002182", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 57.75, "estimated_discounted_cash": 57.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VANCOMYCIN PEAK", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "1000210", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.57, "maximum": 72.17, "gross_charge": 80.19, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.15, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN RESISTANT ENTEROCOCCUS", "code_information": [{"code": "87081", "type": "CPT"}, {"code": "1000832", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.62, "maximum": 35.34, "gross_charge": 39.27, "discounted_cash": 54.17, "estimated_discounted_cash": 39.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 7.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN TROUGH", "code_information": [{"code": "84585", "type": "CPT"}, {"code": "1000101", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.83, "maximum": 103.37, "gross_charge": 91.77, "discounted_cash": 54.17, "estimated_discounted_cash": 91.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 73.41, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.37, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 82.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 52.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANOMYCIN DNA AMP PROBE", "code_information": [{"code": "87500", "type": "CPT"}], "standard_charges": [{"minimum": 40.35, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VANTAS IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9225", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VARDENAFIL HCL 10MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004315", "type": "CDM"}, {"code": "70710107003", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 49.77, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VARIABLE ASPHERICITY LENS", "code_information": [{"code": "V2499", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AG IF", "code_information": [{"code": "87290", "type": "CPT"}], "standard_charges": [{"minimum": 15.43, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER IgG", "code_information": [{"code": "86787", "type": "CPT"}, {"code": "1000208", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.81, "maximum": 68.63, "gross_charge": 76.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER IgM", "code_information": [{"code": "86787", "type": "CPT"}, {"code": "1000369", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.81, "maximum": 68.63, "gross_charge": 76.26, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 61.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 68.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 43.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER IG IM", "code_information": [{"code": "90396", "type": "CPT"}], "standard_charges": [{"minimum": 86.4, "maximum": 86.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ARTERY", "code_information": [{"code": "37242", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE BLEED", "code_information": [{"code": "37244", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ORGAN", "code_information": [{"code": "37243", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE VENOUS", "code_information": [{"code": "37241", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASC GRAFT INTO CARPAL BONE", "code_information": [{"code": "25430", "type": "CPT"}], "standard_charges": [{"minimum": 7009.72, "maximum": 7009.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASCULAR BIOPSY", "code_information": [{"code": "75970", "type": "CPT"}], "standard_charges": [{"minimum": 516.8, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 516.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASCULAR FLOW IMAGING", "code_information": [{"code": "78445", "type": "CPT"}], "standard_charges": [{"minimum": 250.37, "maximum": 250.37, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 250.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93976", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93978", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93979", "type": "CPT"}], "standard_charges": [{"minimum": 353.03, "maximum": 353.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 353.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASCULAR SURGERY SS", "code_information": [{"code": "G4038", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASELINE 1 OZ TUBE", "code_information": [{"code": "3000395", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VASOPNEUMATIC DEVICE THERAPY", "code_information": [{"code": "97016", "type": "CPT"}], "standard_charges": [{"minimum": 11.24, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VASOPRESSIN 20 UN/ML INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "7200082", "type": "CDM"}, {"code": "63323030201", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 30.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOTEC (ENALAPRIL MALEATE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001007", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VASOTEC (ENALAPRIL MALEATE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000181", "type": "CDM"}, {"code": "23155070501", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VBAC CARE AFTER DELIVERY", "code_information": [{"code": "59614", "type": "CPT"}], "standard_charges": [{"minimum": 6928.28, "maximum": 6928.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VBAC CLASS", "code_information": [{"code": "S9439", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY", "code_information": [{"code": "59610", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY ONLY", "code_information": [{"code": "59612", "type": "CPT"}], "standard_charges": [{"minimum": 6928.28, "maximum": 6928.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 6928.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR CONT MNTR", "code_information": [{"code": "95713", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR INTMT MNTR", "code_information": [{"code": "95712", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR UNMONITORED", "code_information": [{"code": "95711", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26 HR UNMNTR", "code_information": [{"code": "95714", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR CONT MNTR", "code_information": [{"code": "95716", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR INTMT MNTR", "code_information": [{"code": "95715", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEHICLE MOD WAIVER/SERVICE", "code_information": [{"code": "T2039", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN BYP FEM-TIBIAL PERONEAL", "code_information": [{"code": "35585", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35583", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN BYP POP-TIBL PERONEAL", "code_information": [{"code": "35587", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN LIGATION AND STRIPPING", "code_information": [{"code": "263", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLAND", "code_information": [{"code": "75840", "type": "CPT"}], "standard_charges": [{"minimum": 165.36, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 165.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLANDS", "code_information": [{"code": "75842", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARM/LEG", "code_information": [{"code": "75820", "type": "CPT"}], "standard_charges": [{"minimum": 142.55, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 142.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARMS/LEGS", "code_information": [{"code": "75822", "type": "CPT"}], "standard_charges": [{"minimum": 173.46, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 173.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY CHEST", "code_information": [{"code": "75827", "type": "CPT"}], "standard_charges": [{"minimum": 154.68, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 154.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY EYE SOCKET", "code_information": [{"code": "75880", "type": "CPT"}], "standard_charges": [{"minimum": 137.32, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 137.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEY", "code_information": [{"code": "75831", "type": "CPT"}], "standard_charges": [{"minimum": 153.81, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 153.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEYS", "code_information": [{"code": "75833", "type": "CPT"}], "standard_charges": [{"minimum": 191.06, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 191.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER", "code_information": [{"code": "75891", "type": "CPT"}], "standard_charges": [{"minimum": 159.59, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 159.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75885", "type": "CPT"}], "standard_charges": [{"minimum": 175.29, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 175.29, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75889", "type": "CPT"}], "standard_charges": [{"minimum": 158.76, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 158.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/O HEMODYN", "code_information": [{"code": "75887", "type": "CPT"}], "standard_charges": [{"minimum": 178.2, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 178.2, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY NECK", "code_information": [{"code": "75860", "type": "CPT"}], "standard_charges": [{"minimum": 162.11, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 162.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL", "code_information": [{"code": "75870", "type": "CPT"}], "standard_charges": [{"minimum": 205.79, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 205.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL EPIDURAL", "code_information": [{"code": "75872", "type": "CPT"}], "standard_charges": [{"minimum": 165.36, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 165.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SPLEEN/LIVER", "code_information": [{"code": "75810", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 3516.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3516.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY TRUNK", "code_information": [{"code": "75825", "type": "CPT"}], "standard_charges": [{"minimum": 147.22, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 147.22, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VELAGLUCERASE ALFA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3385", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VELTASSA (NF-Veltassa) Powder 16.8GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002527", "type": "CDM"}, {"code": "53436016830", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 80.1, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VEMP TEST I&R CERVICAL", "code_information": [{"code": "92517", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R OCULAR", "code_information": [{"code": "92518", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEMP TST I&R CERVICAL&OCULAR", "code_information": [{"code": "92519", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEN BLOOD COLL SNF/HHA", "code_information": [{"code": "G0471", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEN MECHNL THRMBC REPEAT TX", "code_information": [{"code": "37188", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEN THROMBOSIS IMAGES BILAT", "code_information": [{"code": "78458", "type": "CPT"}], "standard_charges": [{"minimum": 248.35, "maximum": 248.35, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 248.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENA CAVA FILTER", "code_information": [{"code": "C1880", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENA GLOBLIN S 50MG/1ML IV SOLN :", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200021", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VENDAJE AC, PER SQ CM", "code_information": [{"code": "Q4279", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENDAJE, PER SQUARE CENTIMET", "code_information": [{"code": "Q4252", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENEER REPAIR", "code_information": [{"code": "D2983", "type": "HCPCS"}], "standard_charges": [{"minimum": 5664.34, "maximum": 5664.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5664.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN 1 YR/>", "code_information": [{"code": "36425", "type": "CPT"}], "standard_charges": [{"minimum": 3504.0, "maximum": 3504.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3504.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN < 1 YR", "code_information": [{"code": "36420", "type": "CPT"}], "standard_charges": [{"minimum": 521.82, "maximum": 521.82, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE HOME/SNF", "code_information": [{"code": "S9529", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENOFER (IRON SUCRO) 100MG/5ML INJ", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J1756", "type": "HCPCS"}, {"code": "7000481", "type": "CDM"}, {"code": "00517234010", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 44.46, "maximum": 267.21, "gross_charge": 78.0, "discounted_cash": 54.17, "estimated_discounted_cash": 234.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 62.4, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 44.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOFER (IRON SUCROSE) 200MG/10ML INJ.", "drug_information": {"unit": 200.0, "type": "EA"}, "code_information": [{"code": "J1756", "type": "HCPCS"}, {"code": "72001108", "type": "CDM"}, {"code": "00517231005", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 133.48, "maximum": 267.21, "gross_charge": 234.19, "discounted_cash": 54.17, "estimated_discounted_cash": 234.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 175.64, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 187.35, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 210.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 133.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS MECH THROMBECTOMY", "code_information": [{"code": "37187", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENOUS PRESSURE CLAMP", "code_information": [{"code": "A4918", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENOUS SAMPLING BY CATHETER", "code_information": [{"code": "75893", "type": "CPT"}], "standard_charges": [{"minimum": 130.68, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENOUS THROMBOSIS IMAGING", "code_information": [{"code": "78457", "type": "CPT"}], "standard_charges": [{"minimum": 217.39, "maximum": 217.39, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 217.39, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENT CIRCUIT DISPOSABLE", "code_information": [{"code": "3001255", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 11.07, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VENT MGMT NF PER DAY", "code_information": [{"code": "94004", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENT MGMT-IP INITIAL DAY", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "11000257", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 794.34, "maximum": 2054.3, "gross_charge": 1393.59, "discounted_cash": 54.17, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1045.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1114.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2054.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1254.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 794.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT MGMT-IP SUBQ DAY", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "11000302", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 794.34, "maximum": 2054.3, "gross_charge": 1393.59, "discounted_cash": 54.17, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1045.19, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 1114.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2054.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 1254.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 794.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [{"code": "32", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "31", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "33", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VER DOC HEAR LOSS", "code_information": [{"code": "G8565", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERAPAMIL HCL ER 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003991", "type": "CDM"}, {"code": "62175048737", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 19.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VERAPAMIL HCL SR CAPSULE 360MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001107", "type": "CDM"}, {"code": "00591288601", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VERAPAMIL HCL TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000464", "type": "CDM"}, {"code": "00378620101", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VERAPAMIL HCL TAB 80MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000485", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VERIFY PT SITE PXD DOCD", "code_information": [{"code": "6100F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERITAS COLLAGEN MATRIX, CM2", "code_information": [{"code": "C9354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERSED (MIDAZOLAM) 2MG INJ", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J2250", "type": "HCPCS"}, {"code": "7000318", "type": "CDM"}, {"code": "63323041112", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERT BITEWINGS 7 TO 8 IMAGES", "code_information": [{"code": "D0277", "type": "HCPCS"}], "standard_charges": [{"minimum": 377.64, "maximum": 377.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 377.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL AXIAL DECOMPRESSIO", "code_information": [{"code": "S9090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERTEBROPLASTY ADDL INJECT", "code_information": [{"code": "22512", "type": "CPT"}], "standard_charges": [{"minimum": 15038.09, "maximum": 15038.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 15038.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERTEPORFIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3396", "type": "HCPCS"}], "standard_charges": [{"minimum": 4607.15, "maximum": 4607.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 4607.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERY LONG CHAIN FATTY ACID", "code_information": [{"code": "82726", "type": "CPT"}, {"code": "1000614", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 22.71, "maximum": 96.2, "gross_charge": 106.89, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESICARE 5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000453", "type": "CDM"}, {"code": "68462038630", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 33.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VESICARE TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000958", "type": "CDM"}, {"code": "51248015001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VESICULOBULLOUS DISEASE CARR", "code_information": [{"code": "D5991", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VESTIBULAR DEV IMPLTJ UNI", "code_information": [{"code": "725T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VESTIBULAR REHAB PER DIEM", "code_information": [{"code": "S9476", "type": "HCPCS"}], "standard_charges": [{"minimum": 737.34, "maximum": 737.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 737.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VESTIBULOPLASTY EXTEN GRAFT", "code_information": [{"code": "D7350", "type": "HCPCS"}], "standard_charges": [{"minimum": 12603.49, "maximum": 12603.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12603.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VESTIBULOPLASTY RIDGE EXTENS", "code_information": [{"code": "D7340", "type": "HCPCS"}], "standard_charges": [{"minimum": 9018.05, "maximum": 9018.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 9018.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIAL ADAPTER", "code_information": [{"code": "3000106", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VIBRATE QUANT SENSORY TEST", "code_information": [{"code": "107T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VICTOZA INJ 6MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "72000758", "type": "CDM"}, {"code": "00169406012", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 523.46, "maximum": 826.52, "gross_charge": 918.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 688.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 734.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 826.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 523.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIM, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4251", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIMPAT (LACOSAMIDE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000895", "type": "CDM"}, {"code": "62332017260", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VIMPAT TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000950", "type": "CDM"}, {"code": "00131247735", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VINBLASTINE SULFATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9360", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VINCRISTINE SULFATE 1 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9370", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VINORELBINE TARTRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9390", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIPER VENOM PROTHROMBIN TIME", "code_information": [{"code": "85612", "type": "CPT"}], "standard_charges": [{"minimum": 20.11, "maximum": 57.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIRAL CULTURE", "code_information": [{"code": "D0416", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITH MCC", "code_information": [{"code": "865", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [{"code": "866", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITH CC/MCC", "code_information": [{"code": "75", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "76", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "VIRUS ANTIBODY NOS", "code_information": [{"code": "86790", "type": "CPT"}], "standard_charges": [{"minimum": 14.81, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE EGGS/ANIMAL", "code_information": [{"code": "87250", "type": "CPT"}], "standard_charges": [{"minimum": 22.49, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE TISSUE ADDL", "code_information": [{"code": "87253", "type": "CPT"}], "standard_charges": [{"minimum": 23.23, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATION SHELL VIA", "code_information": [{"code": "87254", "type": "CPT"}], "standard_charges": [{"minimum": 22.49, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIS 20/40/> W/IN 90 DAYS", "code_information": [{"code": "4175F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIS FIELD ASSMNT TECH SUPPT", "code_information": [{"code": "379T", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIS ITEM/SVC IN OTHER CODE", "code_information": [{"code": "V2797", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 1 PROSTH", "code_information": [{"code": "34845", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 2 PROSTH", "code_information": [{"code": "34846", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 3 PROSTH", "code_information": [{"code": "34847", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 4+ PROST", "code_information": [{"code": "34848", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISCOELASTIC HEEL CUSHION", "code_information": [{"code": "3001146", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE 56M OR LESS", "code_information": [{"code": "G2082", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE, > 56M", "code_information": [{"code": "G2083", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISIT TO DETERM LDCT ELIG", "code_information": [{"code": "G0296", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISTARIL (HYDROXYZINE PAM) 25MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000238", "type": "CDM"}, {"code": "14539067405", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VISTARIL (HYDROXYZINE PAMOATE) CAP 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001910", "type": "CDM"}, {"code": "60687070765", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VISTARIL (HYDROXYZINE)100MG/2ML INJ", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "J3410", "type": "HCPCS"}, {"code": "7000236", "type": "CDM"}, {"code": "00517560225", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL ACUITY SCREEN", "code_information": [{"code": "99173", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISUAL AUDIOMETRY (VRA)", "code_information": [{"code": "92579", "type": "CPT"}], "standard_charges": [{"minimum": 260.72, "maximum": 260.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 260.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISUAL EP SCR ACUITY AUTO", "code_information": [{"code": "333T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST CNS W/I&R", "code_information": [{"code": "95930", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 435.43, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST FOR GLAUCOMA", "code_information": [{"code": "464T", "type": "CPT"}], "standard_charges": [{"minimum": 1005.88, "maximum": 1005.88, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1005.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISUAL FIELD ASSMNT REV/RPRT", "code_information": [{"code": "378T", "type": "CPT"}], "standard_charges": [{"minimum": 232.11, "maximum": 232.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 232.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISUAL FUNCT STATUS ASSESS", "code_information": [{"code": "1055F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISUALIZATION ADJUNCT", "code_information": [{"code": "Q9968", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISUALIZATION OF WINDPIPE", "code_information": [{"code": "31615", "type": "CPT"}], "standard_charges": [{"minimum": 5240.17, "maximum": 5240.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5240.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR HOLE", "code_information": [{"code": "67042", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR PUCKER", "code_information": [{"code": "67041", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIT FOR MEMBRANE DISSECT", "code_information": [{"code": "67043", "type": "CPT"}], "standard_charges": [{"minimum": 10286.94, "maximum": 10286.94, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 10286.94, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VITAL CAPACITY TEST", "code_information": [{"code": "94150", "type": "CPT"}], "standard_charges": [{"minimum": 166.12, "maximum": 166.12, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 166.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VITAL SIGNS RECORDED", "code_information": [{"code": "2010F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VITAMIN A", "code_information": [{"code": "84590", "type": "CPT"}, {"code": "1000776", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.35, "maximum": 58.07, "gross_charge": 64.53, "discounted_cash": 54.17, "estimated_discounted_cash": 64.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 51.62, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 58.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 36.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN A & D OINTMENT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000393", "type": "CDM"}, {"code": "70000035801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.26, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN B COMPLEX TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000380", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN B W/C TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001065", "type": "CDM"}, {"code": "80681015700", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN B1-WHOLE BLD", "code_information": [{"code": "84425", "type": "CPT"}, {"code": "1000503", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 24.41, "maximum": 113.13, "gross_charge": 125.7, "discounted_cash": 54.17, "estimated_discounted_cash": 125.7, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 100.56, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 113.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 71.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN B12", "code_information": [{"code": "82607", "type": "CPT"}, {"code": "1000054", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.34, "maximum": 80.29, "gross_charge": 89.22, "discounted_cash": 54.17, "estimated_discounted_cash": 89.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 71.37, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 40.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 80.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 50.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN B12 (CYANOCOBALAMIN) 1000MCG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3420", "type": "HCPCS"}, {"code": "7000133", "type": "CDM"}, {"code": "69680011210", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN B12 (NF-Vitamin B12) 500MCG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002612", "type": "CDM"}, {"code": "77333093710", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN B12 QUICK DISSOLVE TAB 2500MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001134", "type": "CDM"}, {"code": "54629055100", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN B12(CYANOCOBALAMIN) TAB 1000MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000058", "type": "CDM"}, {"code": "77333093810", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN B2-WHOLE BLOOD", "code_information": [{"code": "84252", "type": "CPT"}, {"code": "1000576", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 23.28, "maximum": 107.81, "gross_charge": 119.79, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 23.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 95.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 107.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 68.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN B6 (PYRIDOXINE) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000224", "type": "CDM"}, {"code": "57896085401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN B6 - PLASMA", "code_information": [{"code": "84207", "type": "CPT"}, {"code": "1000502", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 32.32, "maximum": 149.66, "gross_charge": 166.29, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 133.03, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 149.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 94.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN C", "code_information": [{"code": "82180", "type": "CPT"}, {"code": "1000793", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.37, "maximum": 49.46, "gross_charge": 54.96, "discounted_cash": 54.17, "estimated_discounted_cash": 54.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 43.96, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 49.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN C (ASCORBIC ACID) TAB 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000487", "type": "CDM"}, {"code": "68094011361", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN D 25 HYDROXY", "code_information": [{"code": "82306", "type": "CPT"}, {"code": "1000318", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 34.04, "maximum": 157.7, "gross_charge": 175.23, "discounted_cash": 54.17, "estimated_discounted_cash": 175.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 34.04, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 140.18, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 157.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 99.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN D SRM MICROSAMP QUAN", "code_information": [{"code": "38U", "type": "CPT"}], "standard_charges": [{"minimum": 102.04, "maximum": 102.04, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VITAMIN D,1,25 DI-HYDROXY", "code_information": [{"code": "82652", "type": "CPT"}, {"code": "1000489", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 44.28, "maximum": 205.06, "gross_charge": 227.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 182.28, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 205.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 129.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN D2 (ERGOCALCIFEROL) CAP 50,000IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000328", "type": "CDM"}, {"code": "50268029715", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN D2 (ERGOCALCIFEROL)8000IU/ML GTT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001050", "type": "CDM"}, {"code": "39328035760", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN D2 50,000 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001055", "type": "CDM"}, {"code": "64380073706", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN D3 (CHOLECALCIFEROL) 1000 IU TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000963", "type": "CDM"}, {"code": "80681016800", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN D3 (CHOLECALCIFEROL) 2000IU CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7003748", "type": "CDM"}, {"code": "00536135301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN D3 (CHOLECALCIFEROL) 400 IU TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000898", "type": "CDM"}, {"code": "54629001162", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN D3 (CHOLECALCIFEROL) 50,000IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002755", "type": "CDM"}, {"code": "80681017400", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN D3 (CHOLECALCIFEROL) 5000 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000928", "type": "CDM"}, {"code": "53191024401", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN E", "code_information": [{"code": "84446", "type": "CPT"}, {"code": "1000930", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.31, "maximum": 72.9, "gross_charge": 81.0, "discounted_cash": 54.17, "estimated_discounted_cash": 81.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.8, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 46.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN E CAP 1000 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000641", "type": "CDM"}, {"code": "00904027760", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN E CAP 400 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000274", "type": "CDM"}, {"code": "00536135201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VITAMIN K", "code_information": [{"code": "84597", "type": "CPT"}, {"code": "1000813", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.78, "maximum": 72.0, "gross_charge": 80.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.78, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 45.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN K (PHYTONAD) 10MG/ML INJ", "drug_information": {"unit": 10.0, "type": "EA"}, "code_information": [{"code": "J3430", "type": "HCPCS"}, {"code": "7000488", "type": "CDM"}, {"code": "69097070896", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.11, "maximum": 19.12, "gross_charge": 21.25, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 19.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN K1 (PHYTON) 1MG/0.5ML INJ.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3430", "type": "HCPCS"}, {"code": "72001140", "type": "CDM"}, {"code": "00409915750", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.76, "maximum": 10.67, "gross_charge": 11.86, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 9.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 10.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 6.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN SUPPL 100 CAPS", "code_information": [{"code": "S0194", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VIVAGLOBIN, INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1562", "type": "HCPCS"}], "standard_charges": [{"minimum": 2823.87, "maximum": 2823.87, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 2823.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VKORC1 GENE", "code_information": [{"code": "81355", "type": "CPT"}], "standard_charges": [{"minimum": 101.43, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 101.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VLCAD LEUK NZM ACTV WHL BLD", "code_information": [{"code": "257U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VMA 24HR URINE", "code_information": [{"code": "84545", "type": "CPT"}, {"code": "1000635", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.28, "maximum": 38.72, "gross_charge": 39.09, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 35.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD ANOM/PERSIST SVC", "code_information": [{"code": "93584", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD AZYGS/HEMIAZYGS", "code_information": [{"code": "93585", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD CORONARY SINUS", "code_information": [{"code": "93586", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL AT/ABV", "code_information": [{"code": "93587", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL BELOW", "code_information": [{"code": "93588", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VOL REDUCTION OF BLOOD/PROD", "code_information": [{"code": "86960", "type": "CPT"}], "standard_charges": [{"minimum": 33.57, "maximum": 83.54, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VOLTAGE-GTD CA CHNL ANTB EA", "code_information": [{"code": "86596", "type": "CPT"}], "standard_charges": [{"minimum": 21.16, "maximum": 21.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VOLTAREN (Diclofenac Sodium) 75MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002517", "type": "CDM"}, {"code": "60687065801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VOLTAREN (Diclofenac Sodium) DR 50MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004320", "type": "CDM"}, {"code": "59651084201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VOLTAREN GEL TOPICAL 1%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002747", "type": "CDM"}, {"code": "45802095301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 35.67, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VOLTERAN (DICLOFENAC SOD) 1% GEL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002696", "type": "CDM"}, {"code": "45802095301", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VOLUME DEPLETE OF HARVEST", "code_information": [{"code": "38214", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VOLUMETRIC EXERCISER", "code_information": [{"code": "3000397", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.43, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VOLUMETRIC FLOW METER", "code_information": [{"code": "3000396", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 27.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "VOLUN SERVICE AT HOSPICE", "code_information": [{"code": "G9476", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VON WILLEBRAND FACTOR ANTIGEN", "code_information": [{"code": "85246", "type": "CPT"}, {"code": "1000802", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 26.38, "maximum": 114.56, "gross_charge": 127.29, "discounted_cash": 54.17, "estimated_discounted_cash": 127.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 26.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 101.83, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 57.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 114.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 72.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VONVENDI INJ 1 IU VWF:RCO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7179", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE 200MG INJ", "drug_information": {"unit": 20.0, "type": "EA"}, "code_information": [{"code": "J3465", "type": "HCPCS"}, {"code": "72000989", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 92.34, "maximum": 1147.21, "gross_charge": 162.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1147.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 145.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 92.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC OTH PHY 1ST", "code_information": [{"code": "773T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC OTH PHY EA", "code_information": [{"code": "774T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC SM PHY 1ST", "code_information": [{"code": "771T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC SM PHY EA", "code_information": [{"code": "772T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VR TECHNOLOGY ASSIST THERAPY", "code_information": [{"code": "770T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT 8+ SEG", "code_information": [{"code": "657T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT <7 SEG", "code_information": [{"code": "656T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VTE PROPHYLAXIS RCVD", "code_information": [{"code": "4069F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2B EVAL PLSM", "code_information": [{"code": "283U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2N EVAL PLSM", "code_information": [{"code": "284U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VYJUVEK 5X10^9PFU/ML, 0.1 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3401", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VYTORIN (EZET/SIMVAST) TAB 10/40", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000230", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 4.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Vadadustat, oral, 1 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0901", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Vaginal Specula Lge", "code_information": [{"code": "3001127", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 8.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Vaginal Specula Med", "code_information": [{"code": "3000394", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Vaginal Specula SM", "code_information": [{"code": "3001126", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.66, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Vasc emb/occ w/prs cath", "code_information": [{"code": "C9797", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Vasoreactivity study performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)", "code_information": [{"code": "93896", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Venous-arterial shunt detection with intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)", "code_information": [{"code": "93898", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VersaFoam 10x7.5 Dressing", "code_information": [{"code": "3001116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.28, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Via matrix, per sq cm", "code_information": [{"code": "Q4309", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigatio", "code_information": [{"code": "G0545", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VitoGraft, per square centimeter", "code_information": [{"code": "Q4317", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "W/C COMPONENT-ACCESSORY NOS", "code_information": [{"code": "K0108", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "W/IN 2YR DXA NOT ORDER", "code_information": [{"code": "G9471", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WAIVER SERVICE, NOS", "code_information": [{"code": "T2025", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WALKER EQUALIZER MED BLK", "code_information": [{"code": "3001258", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 116.86, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WALKER FOLDING ADULT", "code_information": [{"code": "3000398", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WARF OR OTHER FDA DRUG PRESC", "code_information": [{"code": "G8967", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WARFARIN RESPON GENETIC TEST", "code_information": [{"code": "G9143", "type": "HCPCS"}], "standard_charges": [{"minimum": 379.16, "maximum": 379.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WARFARIN THERAPY RX", "code_information": [{"code": "4012F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WARMING CARD FOR NWT", "code_information": [{"code": "E0232", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WASH BASIN", "code_information": [{"code": "3000049", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WASH HARVEST STEM CELLS", "code_information": [{"code": "38209", "type": "CPT"}], "standard_charges": [{"minimum": 5461.6, "maximum": 5461.6, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5461.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WASHED RED BLOOD CELLS UNIT", "code_information": [{"code": "P9022", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WATER DISTILLED", "code_information": [{"code": "3000399", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.87, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WATER IRR STER 250ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "3001290", "type": "CDM"}, {"code": "00409613922", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.68, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WATER SOFTENING SYSTEM", "code_information": [{"code": "E1625", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WATERJET PROSTATE ABLTJ CMPL", "code_information": [{"code": "421T", "type": "CPT"}], "standard_charges": [{"minimum": 13701.49, "maximum": 13701.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 13701.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WBC ALKALINE PHOSPHATASE", "code_information": [{"code": "85540", "type": "CPT"}], "standard_charges": [{"minimum": 9.89, "maximum": 17.93, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WBC ANTIBODY IDENTIFICATION", "code_information": [{"code": "86021", "type": "CPT"}], "standard_charges": [{"minimum": 17.31, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WC VAN MILEAGE PER MI", "code_information": [{"code": "S0209", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WCD DEVICE INTERROGATE", "code_information": [{"code": "93292", "type": "CPT"}], "standard_charges": [{"minimum": 123.02, "maximum": 123.02, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEARABLE ARTIFICIAL KIDNEY", "code_information": [{"code": "E1632", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGE BIOPSY OF LIVER", "code_information": [{"code": "47100", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG ADD-ON", "code_information": [{"code": "32506", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG DIAG", "code_information": [{"code": "32507", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG INITIAL", "code_information": [{"code": "32505", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CAST", "code_information": [{"code": "29740", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CLUBFOOT CAST", "code_information": [{"code": "29750", "type": "CPT"}], "standard_charges": [{"minimum": 600.97, "maximum": 600.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 600.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEEKLY SUPPLY MAINT CGS PUMP", "code_information": [{"code": "A4226", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEIGHT MGMT CLASS", "code_information": [{"code": "S9449", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEIGHT RECORD", "code_information": [{"code": "2001F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WELCHOL TAB 625MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000574", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WELLBUTRIN (BUPROPION HCL) TAB 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000802", "type": "CDM"}, {"code": "23155019201", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 11.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WELLBUTRIN (BUPROPION) SR 150MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7004197", "type": "CDM"}, {"code": "00591354160", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WELLBUTRIN HCL SR (BUPROPION ER) 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001120", "type": "CDM"}, {"code": "68084069701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WELLBUTRIN XL (BUPROPION HCL) TAB 150MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000225", "type": "CDM"}, {"code": "00904708461", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WELLBUTRIN XL 300MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002444", "type": "CDM"}, {"code": "60687079321", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.62, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WELLNESS ASSESSMENT BY NONPH", "code_information": [{"code": "S5190", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS ANTIBODY", "code_information": [{"code": "86788", "type": "CPT"}, {"code": "1000317", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.38, "maximum": 96.7, "gross_charge": 97.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 87.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS ANTIBODY", "code_information": [{"code": "86789", "type": "CPT"}], "standard_charges": [{"minimum": 16.55, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS Ab PANEL", "code_information": [{"code": "86788", "type": "CPT"}, {"code": "1000921", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.38, "maximum": 96.7, "gross_charge": 97.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 87.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 55.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WESTERN BLOT FOR LYME DISEASE", "code_information": [{"code": "86618", "type": "CPT"}, {"code": "1000562", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.58, "maximum": 96.7, "gross_charge": 94.71, "discounted_cash": 54.17, "estimated_discounted_cash": 94.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 75.76, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 85.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 53.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WESTERN BLOT TEST", "code_information": [{"code": "84181", "type": "CPT"}], "standard_charges": [{"minimum": 19.58, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WET MOUNTS/ W PREPARATIONS", "code_information": [{"code": "Q0111", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WET PREP", "code_information": [{"code": "88150", "type": "CPT"}, {"code": "1000102", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 18.31, "maximum": 55.12, "gross_charge": 43.59, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 34.87, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 39.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 24.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WET-DRY DRESSINGS RX RECMD", "code_information": [{"code": "4265F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR HEAVY DUTY FIXED", "code_information": [{"code": "E1285", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR HVY DUTY DETACH A", "code_information": [{"code": "E1290", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR LIGHTWEIGHT DET A", "code_information": [{"code": "E1090", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR LIGHTWT FIXED ARM", "code_information": [{"code": "E1089", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR LIGHTWT FIXED ARM", "code_information": [{"code": "E1250", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR LIGHTWT FOOT REST", "code_information": [{"code": "E1260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR MNGMENT TRAINING", "code_information": [{"code": "97542", "type": "CPT"}], "standard_charges": [{"minimum": 30.15, "maximum": 589.34, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 589.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR NO. 2 FOOTPLATES", "code_information": [{"code": "E0970", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR STANDARD DETACH A", "code_information": [{"code": "E1140", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHEELED CART, PORT CYL/CONC", "code_information": [{"code": "E1354", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHIRLPOOL PORTABLE", "code_information": [{"code": "E1300", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHIRLPOOL THERAPY", "code_information": [{"code": "97022", "type": "CPT"}], "standard_charges": [{"minimum": 16.02, "maximum": 103.18, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 103.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHIRLPOOL TUB WALKIN PORTABL", "code_information": [{"code": "E1301", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHITE BLOOD CELL COUNT", "code_information": [{"code": "85048", "type": "CPT"}, {"code": "1000988", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.92, "maximum": 17.93, "gross_charge": 15.06, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHLCHR SPECIAL SIZE/CONSTRC", "code_information": [{"code": "E1220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHLCHR STAND FXD ARM FT REST", "code_information": [{"code": "E1130", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHOLE BLOOD FOR TRANSFUSION", "code_information": [{"code": "P9010", "type": "HCPCS"}], "standard_charges": [{"minimum": 1469.15, "maximum": 1469.15, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHOLE BODY PHOTOGRAPHY", "code_information": [{"code": "96904", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81460", "type": "CPT"}], "standard_charges": [{"minimum": 1289.49, "maximum": 1480.05, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1480.05, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81465", "type": "CPT"}], "standard_charges": [{"minimum": 379.16, "maximum": 1076.4, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1076.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 379.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WIG ANY TYPE", "code_information": [{"code": "A9282", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WILATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7183", "type": "HCPCS"}], "standard_charges": [{"minimum": 12412.57, "maximum": 12412.57, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 12412.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WINDOWING OF CAST", "code_information": [{"code": "29730", "type": "CPT"}], "standard_charges": [{"minimum": 138.66, "maximum": 138.66, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WIRELESS PRESSURE SENSOR", "code_information": [{"code": "C2624", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL CM", "code_information": [{"code": "15005", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WNDEX FLW, BIOSKN FLW, 0.5CC", "code_information": [{"code": "Q4162", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING", "code_information": [{"code": "97545", "type": "CPT"}], "standard_charges": [{"minimum": 156.94, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 156.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING ADD-ON", "code_information": [{"code": "97546", "type": "CPT"}], "standard_charges": [{"minimum": 62.02, "maximum": 763.85, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 62.02, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 763.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WORK RELATED DISABILITY EXAM", "code_information": [{"code": "99455", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND CHAR SIZE ETC DOCD", "code_information": [{"code": "2050F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND CLEANSER ANY TYPE/SIZE", "code_information": [{"code": "A6260", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND CLEANSER SPRAY", "code_information": [{"code": "3001111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.85, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "WOUND CLOSURE BY ADHESIVE", "code_information": [{"code": "G0168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "464", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "463", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "465", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [{"code": "902", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [{"code": "901", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "903", "type": "MS-DRG"}], "standard_charges": [{"minimum": 975.0, "maximum": 3129.0, "discounted_cash": 850.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 975.0, "methodology": "per diem"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3129.0, "methodology": "per diem"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2160.69, "methodology": "per diem"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1288.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "WOUND FILLER DRY FORM / GRAM", "code_information": [{"code": "A6262", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND FILLER GEL/PASTE /OZ", "code_information": [{"code": "A6261", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND PREP ADDL 100 CM", "code_information": [{"code": "15003", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND PREP F/N/HF/G", "code_information": [{"code": "15004", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "15002", "type": "CPT"}], "standard_charges": [{"minimum": 3667.07, "maximum": 3667.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3667.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND SRFC CULTURETECH USED", "code_information": [{"code": "4260F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND WARMING DEVICE", "code_information": [{"code": "E0231", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND WARMING WOUND COVER", "code_information": [{"code": "A6000", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUND(S) CARE NON-SELECTIVE", "code_information": [{"code": "97602", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUNDEX, BIOSKIN, PER SQ CM", "code_information": [{"code": "Q4163", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WOUNDFIX BIOWOUND PLUS XPLUS", "code_information": [{"code": "Q4217", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY", "code_information": [{"code": "29840", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29843", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29844", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29845", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29846", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29847", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRIST ENDOSCOPY/SURGERY", "code_information": [{"code": "29848", "type": "CPT"}], "standard_charges": [{"minimum": 7134.64, "maximum": 7134.64, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 7134.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRIST REPLACEMENT", "code_information": [{"code": "25446", "type": "CPT"}], "standard_charges": [{"minimum": 29754.44, "maximum": 29754.44, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 29754.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRITTEN DISCHARGE INSTR PRVD", "code_information": [{"code": "4014F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRLS SKN SNR ANISOTROPY MEAS", "code_information": [{"code": "639T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRMNG 4 SURG NORMOTHERMIA", "code_information": [{"code": "4250F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Walker, battery power wheels", "code_information": [{"code": "E0152", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type", "code_information": [{"code": "E1033", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type", "code_information": [{"code": "E1034", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface", "code_information": [{"code": "E1032", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Wheelchair transit securement system, includes all components and accessories", "code_information": [{"code": "E1023", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Wheelchair transportation securement system, any type includes all components and accessories", "code_information": [{"code": "E1022", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WoundPlus, per square centimeter", "code_information": [{"code": "Q4326", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81470", "type": "CPT"}], "standard_charges": [{"minimum": 1051.1, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1051.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81471", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 1289.49, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY AORTA LEG ARTERIES", "code_information": [{"code": "75630", "type": "CPT"}], "standard_charges": [{"minimum": 207.03, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 207.03, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY ASSAY CALCULUS", "code_information": [{"code": "82370", "type": "CPT"}], "standard_charges": [{"minimum": 14.4, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY BEND ONLY L-S SPINE", "code_information": [{"code": "72120", "type": "CPT"}], "standard_charges": [{"minimum": 51.79, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE DUCT DILATION", "code_information": [{"code": "74363", "type": "CPT"}], "standard_charges": [{"minimum": 150.45, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 150.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE DUCT ENDOSCOPY", "code_information": [{"code": "74328", "type": "CPT"}], "standard_charges": [{"minimum": 96.79, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 96.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE DUCTS/PANCREAS", "code_information": [{"code": "74300", "type": "CPT"}], "standard_charges": [{"minimum": 47.55, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE/PANC ENDOSCOPY", "code_information": [{"code": "74330", "type": "CPT"}], "standard_charges": [{"minimum": 134.24, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY CONSULTATION", "code_information": [{"code": "76140", "type": "CPT"}], "standard_charges": [{"minimum": 87.58, "maximum": 87.58, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 87.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ABDOMEN 3+ VIEWS", "code_information": [{"code": "74021", "type": "CPT"}], "standard_charges": [{"minimum": 54.96, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 2/3 VW", "code_information": [{"code": "72082", "type": "CPT"}], "standard_charges": [{"minimum": 88.79, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 88.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 4/5 VW", "code_information": [{"code": "72083", "type": "CPT"}], "standard_charges": [{"minimum": 99.35, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 99.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 6/> VW", "code_information": [{"code": "72084", "type": "CPT"}], "standard_charges": [{"minimum": 124.58, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 124.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM HIP UNI 1 VIEW", "code_information": [{"code": "73501", "type": "CPT"}], "standard_charges": [{"minimum": 41.21, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM HIP UNI 4/> VIEWS", "code_information": [{"code": "73503", "type": "CPT"}], "standard_charges": [{"minimum": 74.46, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 74.46, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM HIPS BI 2 VIEWS", "code_information": [{"code": "73521", "type": "CPT"}], "standard_charges": [{"minimum": 52.21, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM HIPS BI 5/> VIEWS", "code_information": [{"code": "73523", "type": "CPT"}], "standard_charges": [{"minimum": 77.57, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 77.57, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM KNEE 4 OR MORE", "code_information": [{"code": "73564", "type": "CPT"}], "standard_charges": [{"minimum": 58.43, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.43, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 195.73, "count": "1 through 10", "median_amount": 195.73, "methodology": "percent of total billed charges", "10th_percentile": 195.73, "90th_percentile": 195.73}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM NECK SPINE 4/5VWS", "code_information": [{"code": "72050", "type": "CPT"}], "standard_charges": [{"minimum": 67.41, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF ANKLE", "code_information": [{"code": "73600", "type": "CPT"}], "standard_charges": [{"minimum": 40.69, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF ANKLE", "code_information": [{"code": "73610", "type": "CPT"}], "standard_charges": [{"minimum": 46.55, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 189.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_percentage": 80.0, "possible_amount": 75.28, "count": "1 through 10", "median_amount": 75.28, "methodology": "percent of total billed charges", "10th_percentile": 75.28, "90th_percentile": 75.28}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 91.32, "count": "1 through 10", "median_amount": 76.41, "methodology": "percent of total billed charges", "10th_percentile": 76.41, "90th_percentile": 106.23}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF BODY SECTION", "code_information": [{"code": "76100", "type": "CPT"}], "standard_charges": [{"minimum": 114.71, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 114.71, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF COLLAR BONE", "code_information": [{"code": "73000", "type": "CPT"}], "standard_charges": [{"minimum": 40.69, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF ELBOW", "code_information": [{"code": "73070", "type": "CPT"}], "standard_charges": [{"minimum": 36.96, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF ELBOW", "code_information": [{"code": "73080", "type": "CPT"}], "standard_charges": [{"minimum": 41.16, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 76.41, "count": "1 through 10", "median_amount": 76.41, "methodology": "percent of total billed charges", "10th_percentile": 76.41, "90th_percentile": 76.41}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FEMUR 1", "code_information": [{"code": "73551", "type": "CPT"}], "standard_charges": [{"minimum": 36.96, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FEMUR 2/>", "code_information": [{"code": "73552", "type": "CPT"}], "standard_charges": [{"minimum": 44.53, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 195.73, "count": "1 through 10", "median_amount": 195.73, "methodology": "percent of total billed charges", "10th_percentile": 195.73, "90th_percentile": 195.73}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FINGER(S)", "code_information": [{"code": "73140", "type": "CPT"}], "standard_charges": [{"minimum": 47.18, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 47.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FISTULA", "code_information": [{"code": "76080", "type": "CPT"}], "standard_charges": [{"minimum": 77.99, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FOOT", "code_information": [{"code": "73620", "type": "CPT"}], "standard_charges": [{"minimum": 35.72, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 35.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FOOT", "code_information": [{"code": "73630", "type": "CPT"}], "standard_charges": [{"minimum": 43.65, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FOREARM", "code_information": [{"code": "73090", "type": "CPT"}], "standard_charges": [{"minimum": 36.96, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF HAND", "code_information": [{"code": "73120", "type": "CPT"}], "standard_charges": [{"minimum": 39.45, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF HAND", "code_information": [{"code": "73130", "type": "CPT"}], "standard_charges": [{"minimum": 46.14, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 96.29, "count": "1 through 10", "median_amount": 106.22, "methodology": "percent of total billed charges", "10th_percentile": 76.41, "90th_percentile": 106.23}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF HEEL", "code_information": [{"code": "73650", "type": "CPT"}], "standard_charges": [{"minimum": 36.55, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 76.41, "count": "1 through 10", "median_amount": 76.41, "methodology": "percent of total billed charges", "10th_percentile": 76.41, "90th_percentile": 76.41}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF HUMERUS", "code_information": [{"code": "73060", "type": "CPT"}], "standard_charges": [{"minimum": 40.28, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 76.41, "count": "1 through 10", "median_amount": 76.41, "methodology": "percent of total billed charges", "10th_percentile": 76.41, "90th_percentile": 76.41}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINT", "code_information": [{"code": "70332", "type": "CPT"}], "standard_charges": [{"minimum": 109.94, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 109.94, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF KIDNEY LESION", "code_information": [{"code": "74470", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 599.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 599.96, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF KNEE 1 OR 2", "code_information": [{"code": "73560", "type": "CPT"}], "standard_charges": [{"minimum": 43.18, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF KNEE 3", "code_information": [{"code": "73562", "type": "CPT"}], "standard_charges": [{"minimum": 51.59, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 273.59, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF LOWER LEG", "code_information": [{"code": "73590", "type": "CPT"}], "standard_charges": [{"minimum": 39.86, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 76.41, "count": "1 through 10", "median_amount": 76.41, "methodology": "percent of total billed charges", "10th_percentile": 76.41, "90th_percentile": 76.41}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MASTOIDS", "code_information": [{"code": "70120", "type": "CPT"}], "standard_charges": [{"minimum": 49.1, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MASTOIDS", "code_information": [{"code": "70130", "type": "CPT"}], "standard_charges": [{"minimum": 79.82, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 79.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MIDDLE EAR", "code_information": [{"code": "70134", "type": "CPT"}], "standard_charges": [{"minimum": 78.14, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PELVIS", "code_information": [{"code": "72190", "type": "CPT"}], "standard_charges": [{"minimum": 53.61, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.61, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PENIS", "code_information": [{"code": "74445", "type": "CPT"}], "standard_charges": [{"minimum": 151.09, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 151.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERINEUM", "code_information": [{"code": "74775", "type": "CPT"}], "standard_charges": [{"minimum": 292.55, "maximum": 292.55, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 292.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERITONEUM", "code_information": [{"code": "74190", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 599.13, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 599.13, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SALIVARY DUCT", "code_information": [{"code": "70390", "type": "CPT"}], "standard_charges": [{"minimum": 151.8, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 151.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SALIVARY GLAND", "code_information": [{"code": "70380", "type": "CPT"}], "standard_charges": [{"minimum": 47.8, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 47.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SHOULDER", "code_information": [{"code": "73020", "type": "CPT"}], "standard_charges": [{"minimum": 27.37, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SHOULDER", "code_information": [{"code": "73030", "type": "CPT"}], "standard_charges": [{"minimum": 43.7, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 43.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 106.23, "count": "1 through 10", "median_amount": 106.23, "methodology": "percent of total billed charges", "10th_percentile": 106.23, "90th_percentile": 106.23}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SHOULDER BLADE", "code_information": [{"code": "73010", "type": "CPT"}], "standard_charges": [{"minimum": 30.38, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEAR DUCT", "code_information": [{"code": "70170", "type": "CPT"}], "standard_charges": [{"minimum": 286.7, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 286.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEETH", "code_information": [{"code": "70300", "type": "CPT"}], "standard_charges": [{"minimum": 16.32, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 16.32, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEETH", "code_information": [{"code": "70310", "type": "CPT"}], "standard_charges": [{"minimum": 48.16, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TOE(S)", "code_information": [{"code": "73660", "type": "CPT"}], "standard_charges": [{"minimum": 36.8, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF WRIST", "code_information": [{"code": "73100", "type": "CPT"}], "standard_charges": [{"minimum": 42.77, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF WRIST", "code_information": [{"code": "73110", "type": "CPT"}], "standard_charges": [{"minimum": 51.53, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.53, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_percentage": 57.0, "possible_amount": 106.23, "count": "1 through 10", "median_amount": 106.23, "methodology": "percent of total billed charges", "10th_percentile": 106.23, "90th_percentile": 106.23}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM PITUITARY SADDLE", "code_information": [{"code": "70240", "type": "CPT"}], "standard_charges": [{"minimum": 42.1, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM RIBS BIL 3 VIEWS", "code_information": [{"code": "71110", "type": "CPT"}], "standard_charges": [{"minimum": 55.89, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM RIBS UNI 2 VIEWS", "code_information": [{"code": "71100", "type": "CPT"}], "standard_charges": [{"minimum": 46.82, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM SI JOINTS", "code_information": [{"code": "72200", "type": "CPT"}], "standard_charges": [{"minimum": 41.58, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM SURGICAL SPECIMEN", "code_information": [{"code": "76098", "type": "CPT"}], "standard_charges": [{"minimum": 51.87, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM THORAC SPINE 2VWS", "code_information": [{"code": "72070", "type": "CPT"}], "standard_charges": [{"minimum": 41.73, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.73, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM THORAC SPINE4/>VW", "code_information": [{"code": "72074", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 56.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM UNILAT RIBS/CHEST", "code_information": [{"code": "71101", "type": "CPT"}], "standard_charges": [{"minimum": 53.72, "maximum": 182.71, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY FALLOPIAN TUBE", "code_information": [{"code": "74742", "type": "CPT"}], "standard_charges": [{"minimum": 106.68, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY FEMALE GENITAL TRACT", "code_information": [{"code": "74740", "type": "CPT"}], "standard_charges": [{"minimum": 124.0, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY FOR PANCREAS ENDOSCOPY", "code_information": [{"code": "74329", "type": "CPT"}], "standard_charges": [{"minimum": 83.07, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 83.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE GI DILATION", "code_information": [{"code": "74360", "type": "CPT"}], "standard_charges": [{"minimum": 141.24, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 141.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE INTESTINAL TUBE", "code_information": [{"code": "74355", "type": "CPT"}], "standard_charges": [{"minimum": 170.21, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 170.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY HEAD FOR ORTHODONTIA", "code_information": [{"code": "70350", "type": "CPT"}], "standard_charges": [{"minimum": 20.83, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY MALE GENITAL TRACT", "code_information": [{"code": "74440", "type": "CPT"}], "standard_charges": [{"minimum": 124.82, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 124.82, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY OF LOWER SPINE DISK", "code_information": [{"code": "72295", "type": "CPT"}], "standard_charges": [{"minimum": 143.83, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 143.83, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCT", "code_information": [{"code": "77053", "type": "CPT"}], "standard_charges": [{"minimum": 67.89, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCTS", "code_information": [{"code": "77054", "type": "CPT"}], "standard_charges": [{"minimum": 87.45, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 87.45, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY SM INT F-THRU STD", "code_information": [{"code": "74248", "type": "CPT"}], "standard_charges": [{"minimum": 109.11, "maximum": 109.11, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 109.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY STRESS VIEW", "code_information": [{"code": "77071", "type": "CPT"}], "standard_charges": [{"minimum": 70.72, "maximum": 70.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 70.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY URETHRA/BLADDER", "code_information": [{"code": "74450", "type": "CPT"}], "standard_charges": [{"minimum": 287.11, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 287.11, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY URETHRA/BLADDER", "code_information": [{"code": "74455", "type": "CPT"}], "standard_charges": [{"minimum": 133.68, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 133.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY XM COLON 1CNTRST STD", "code_information": [{"code": "74270", "type": "CPT"}], "standard_charges": [{"minimum": 201.76, "maximum": 201.76, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY XM COLON 2CNTRST STD", "code_information": [{"code": "74280", "type": "CPT"}], "standard_charges": [{"minimum": 289.65, "maximum": 289.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 289.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY XM ESOPHAGUS 1CNTRST", "code_information": [{"code": "74220", "type": "CPT"}], "standard_charges": [{"minimum": 128.09, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 128.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY XM ESOPHAGUS 2CNTRST", "code_information": [{"code": "74221", "type": "CPT"}], "standard_charges": [{"minimum": 144.38, "maximum": 144.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 144.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY XM PHRNX&/CRV ESOPH C+", "code_information": [{"code": "74210", "type": "CPT"}], "standard_charges": [{"minimum": 126.79, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 126.79, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SM INT 2CNTRST STD", "code_information": [{"code": "74251", "type": "CPT"}], "standard_charges": [{"minimum": 294.16, "maximum": 294.16, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 294.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SWLNG FUNCJ C+", "code_information": [{"code": "74230", "type": "CPT"}], "standard_charges": [{"minimum": 164.65, "maximum": 164.65, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 164.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAY/CT/ULTRSND ET AL ORD", "code_information": [{"code": "3319F", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAYS AT SURGERY ADD-ON", "code_information": [{"code": "74301", "type": "CPT"}], "standard_charges": [{"minimum": 36.84, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE LENGTH STUDIES", "code_information": [{"code": "77073", "type": "CPT"}], "standard_charges": [{"minimum": 57.41, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 57.41, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY INFANT", "code_information": [{"code": "77076", "type": "CPT"}], "standard_charges": [{"minimum": 136.49, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 136.49, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY LIMITED", "code_information": [{"code": "77074", "type": "CPT"}], "standard_charges": [{"minimum": 83.25, "maximum": 182.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 83.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-RAYS TRANSCATH THERAPY", "code_information": [{"code": "75894", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 1236.51, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1236.51, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XALATAN OPHTH SOLN 0.005%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000620", "type": "CDM"}, {"code": "61314054701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 44.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XANAX (ALPRAZOLAM) TAB 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000020", "type": "CDM"}, {"code": "65862067601", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XANAX (ALPRAZOLAM) TAB 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000220", "type": "CDM"}, {"code": "65862067701", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XARELTO (NF-Xarelto) 20MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002636", "type": "CDM"}, {"code": "50458057930", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XARELTO TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000932", "type": "CDM"}, {"code": "50458058030", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XARELTO TAB 15MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000975", "type": "CDM"}, {"code": "50458057830", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL CPLX W/ECP", "code_information": [{"code": "66987", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL CPLX WO ECP", "code_information": [{"code": "66982", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL INSJ 1+", "code_information": [{"code": "66991", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/ECP", "code_information": [{"code": "66988", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/O ECP", "code_information": [{"code": "66984", "type": "CPT"}], "standard_charges": [{"minimum": 5502.03, "maximum": 5502.03, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 5502.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCELL AMNIO MATRIX PER SQ CM", "code_information": [{"code": "Q4280", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCELLERATE, PER SQ CM", "code_information": [{"code": "Q4234", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCELLISTEM, 1 MG", "code_information": [{"code": "A2004", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCM BIOLOGIC TISS MATRIX 1CM", "code_information": [{"code": "Q4142", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCPSL CTRC RMVL CPLX INSJ 1+", "code_information": [{"code": "66989", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XE133 XENON 10MCI", "code_information": [{"code": "A9558", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XENOGRAFT IMPLTJ ARTCLR SURF", "code_information": [{"code": "737T", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XEROFORM DRSG 1X8", "code_information": [{"code": "3000401", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XEROFORM DRSG 2X2", "code_information": [{"code": "3001463", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XEROFORM DRSG 4X4", "code_information": [{"code": "3000402", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XEROFORM DRSG 5X9", "code_information": [{"code": "3000403", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XIFAXAN (RIFAXIMIN) 550MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002954", "type": "CDM"}, {"code": "65649030303", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 159.41, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XK GNOTYP XK EXONS 1-3", "code_information": [{"code": "200U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XM ARCHIVE TISSUE MOLEC ANAL", "code_information": [{"code": "88363", "type": "CPT"}], "standard_charges": [{"minimum": 21.47, "maximum": 30.71, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.47, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XOME TUM & NML SPEC SEQ ALYS", "code_information": [{"code": "36U", "type": "CPT"}], "standard_charges": [{"minimum": 138.28, "maximum": 138.28, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 138.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XOPENEX (LEVALBUTEROL) INH 0.63MG/3ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000489", "type": "CDM"}, {"code": "66993002227", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.3, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XOPENEX (LEVALBUTEROL) INH 1.25MG/3ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200060", "type": "CDM"}, {"code": "00115993278", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR ABD AP AND DECUB", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "2000006", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 46.87, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ABD AP AND LATERAL", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "2000007", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 46.87, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ABD AP FLAT (KUB)", "code_information": [{"code": "74018", "type": "CPT"}, {"code": "2000002", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 38.31, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 38.31, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ABD FLAT AND ERECT", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "2000003", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 46.87, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 46.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ABD FLAT DECUB AND AP CXR", "code_information": [{"code": "74022", "type": "CPT"}, {"code": "2000005", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 63.52, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 63.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ABD FOR TUBE PLACEMENT W/ CONTRAST", "code_information": [{"code": "74340", "type": "CPT"}, {"code": "2000141", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 42.73, "maximum": 573.7, "gross_charge": 74.97, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 130.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 59.97, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 67.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 42.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR AC JOINTS BILAT", "code_information": [{"code": "73050", "type": "CPT"}, {"code": "2000008", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 36.24, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 36.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ACUTE ABD SERIES", "code_information": [{"code": "74022", "type": "CPT"}, {"code": "2000004", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 63.52, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 63.52, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ANKLE LT LIMITED", "code_information": [{"code": "2000009", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR ANKLE LT MULTI VIEW", "code_information": [{"code": "2000010", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR ANKLE RT LIMITED", "code_information": [{"code": "2000011", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR ANKLE RT MULTI VIEW", "code_information": [{"code": "2000012", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR BONE AGE STUDY", "code_information": [{"code": "77072", "type": "CPT"}, {"code": "2000146", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 33.38, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR C SPINE LIMITED", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "2000096", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 50.14, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR C SPINE MULTI VIEW", "code_information": [{"code": "72052", "type": "CPT"}, {"code": "2000089", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 78.35, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR CHEST 4 VIEW", "code_information": [{"code": "71048", "type": "CPT"}, {"code": "2000111", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 58.9, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR CHEST LAT DECUB", "code_information": [{"code": "71047", "type": "CPT"}, {"code": "2000112", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 53.72, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR CHEST MULTI VIEW", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "2000110", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 42.67, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR CHEST SINGLE VIEW", "code_information": [{"code": "71045", "type": "CPT"}, {"code": "2000113", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 32.92, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 188.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 32.92, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR CHEST W/ APICAL LORDOTIC", "code_information": [{"code": "71047", "type": "CPT"}, {"code": "2000114", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 53.72, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 53.72, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR CHEST W/ OBLIQUE", "code_information": [{"code": "71048", "type": "CPT"}, {"code": "2000115", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 58.9, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 58.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR CLAVICLE LT", "code_information": [{"code": "2000016", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR CLAVICLE RT", "code_information": [{"code": "2000017", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR CXR/ABD F BODY (CHILD NOSE TO REC AP)", "code_information": [{"code": "76010", "type": "CPT"}, {"code": "2000019", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 37.9, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 37.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ELBOW LT LIMITED", "code_information": [{"code": "2000021", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR ELBOW LT MULTI VIEW", "code_information": [{"code": "2000022", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR ELBOW RT LIMITED", "code_information": [{"code": "2000023", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR ELBOW RT MULTI VIEW", "code_information": [{"code": "2000020", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR EYE (FOREIGN BODY)", "code_information": [{"code": "70030", "type": "CPT"}, {"code": "2000024", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 41.21, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR FACIAL BONES LIMITED", "code_information": [{"code": "70140", "type": "CPT"}, {"code": "2000026", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 40.85, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR FACIAL BONES MULTI VIEW", "code_information": [{"code": "70150", "type": "CPT"}, {"code": "2000025", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 60.3, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 60.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR FEMUR LT MULTI VIEW", "code_information": [{"code": "2000027", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FEMUR RT MULTI VIEW", "code_information": [{"code": "2000028", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER LT 1ST", "code_information": [{"code": "2000029", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER LT 2ND", "code_information": [{"code": "2000131", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER LT 3RD", "code_information": [{"code": "2000132", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER LT 4TH", "code_information": [{"code": "2000133", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER LT 5TH", "code_information": [{"code": "2000134", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER RT 1ST", "code_information": [{"code": "2000030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER RT 2ND", "code_information": [{"code": "2000135", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER RT 3RD", "code_information": [{"code": "2000136", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER RT 4TH", "code_information": [{"code": "2000137", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FINGER RT 5TH", "code_information": [{"code": "2000138", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FOOT LT LIMITED", "code_information": [{"code": "2000031", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FOOT LT MULTI VIEW", "code_information": [{"code": "2000032", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FOOT RT LIMITED", "code_information": [{"code": "2000033", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FOOT RT MULTI VIEW", "code_information": [{"code": "2000034", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FOREARM LT MULTI VIEW", "code_information": [{"code": "2000035", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR FOREARM RT MULTI VIEW", "code_information": [{"code": "2000036", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR GI SERIES", "code_information": [{"code": "74240", "type": "CPT"}, {"code": "2000037", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 160.66, "maximum": 682.39, "gross_charge": 758.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 160.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 606.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 682.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 432.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR GI SERIES DOUBLE CONTRAST", "code_information": [{"code": "74246", "type": "CPT"}, {"code": "2000038", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 183.18, "maximum": 682.39, "gross_charge": 758.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 183.18, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 606.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 682.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 432.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR HAND LT LIMITED", "code_information": [{"code": "2000040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR HAND LT MULTI VIEW", "code_information": [{"code": "2000041", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR HAND RT LIMITED", "code_information": [{"code": "2000042", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR HAND RT MULTI VIEW", "code_information": [{"code": "2000043", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR HIP LT MULTI VIEW", "code_information": [{"code": "2000044", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR HIP RT MULTI VIEW", "code_information": [{"code": "2000045", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR HIPS BILAT MULTI VIEW", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "2000046", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 67.93, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.93, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR HUMERUS LT MULTI VIEW", "code_information": [{"code": "2000047", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR HUMERUS RT MULTI VIEW", "code_information": [{"code": "2000048", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR HUNTMAN CHEST 2V", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "2000116", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 22.8, "maximum": 182.71, "gross_charge": 40.0, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.67, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR IVP", "code_information": [{"code": "74400", "type": "CPT"}, {"code": "2000049", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 173.95, "maximum": 682.39, "gross_charge": 758.22, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 173.95, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 606.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 682.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 432.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR KNEE BILAT MULTI VIEW", "code_information": [{"code": "73565", "type": "CPT"}, {"code": "2000058", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 51.07, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR KNEE LT (1 OR 2 V)", "code_information": [{"code": "2000052", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR KNEE LT 3V", "code_information": [{"code": "2000051", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR KNEE LT MULTI VIEW", "code_information": [{"code": "2000050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR KNEE LT W/ TUNNEL", "code_information": [{"code": "2000053", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR KNEE RT (1 OR 2 V)", "code_information": [{"code": "2000056", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR KNEE RT 3V", "code_information": [{"code": "2000055", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR KNEE RT MULTI VIEW", "code_information": [{"code": "2000054", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR KNEE RT W/ TUNNEL", "code_information": [{"code": "2000057", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR KNEE STANDING UNILAT", "code_information": [{"code": "73565", "type": "CPT"}, {"code": "2000140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 51.07, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR L SPINE LIMITED", "code_information": [{"code": "72100", "type": "CPT"}, {"code": "2000091", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 50.55, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 50.55, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR L SPINE MULTI VIEW", "code_information": [{"code": "72110", "type": "CPT"}, {"code": "2000090", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 64.86, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 64.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR LOW EXTREMITY (CHILD)", "code_information": [{"code": "73592", "type": "CPT"}, {"code": "2000059", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 40.28, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR MANDIBLE LIMITED", "code_information": [{"code": "70100", "type": "CPT"}, {"code": "2000061", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 48.68, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.68, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR MANDIBLE MULTI VIEW", "code_information": [{"code": "70110", "type": "CPT"}, {"code": "2000060", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 55.69, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 55.69, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR NASAL BONE", "code_information": [{"code": "70160", "type": "CPT"}, {"code": "2000062", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 48.21, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.21, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR OPTIC FORAMINA", "code_information": [{"code": "70190", "type": "CPT"}, {"code": "2000064", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 48.42, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.42, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR ORBITS", "code_information": [{"code": "70200", "type": "CPT"}, {"code": "2000065", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.65, "maximum": 191.26, "gross_charge": 212.52, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 61.65, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 170.01, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 191.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 121.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR OS CALCIS LT (HEEL)", "code_information": [{"code": "2000066", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR OS CALCIS RT (HEEL)", "code_information": [{"code": "2000067", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR PELVIS AP ONLY", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "2000068", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 35.35, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 35.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR PELVIS/HIPS INFANT/CHILD", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "2000069", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 59.26, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR RIBS BILATERAL", "code_information": [{"code": "71111", "type": "CPT"}, {"code": "2000070", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 66.84, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 66.84, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR RIBS LT UNILAT", "code_information": [{"code": "2000071", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR RIBS RT UNILAT", "code_information": [{"code": "2000072", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SACROILLIAC JOINTS", "code_information": [{"code": "72202", "type": "CPT"}, {"code": "2000073", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 49.77, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SACRUM / COCCYX", "code_information": [{"code": "72220", "type": "CPT"}, {"code": "2000074", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 41.16, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SCAPULA LT", "code_information": [{"code": "2000075", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SCAPULA RT", "code_information": [{"code": "2000076", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 343.38, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SHOULDER LT 1V", "code_information": [{"code": "2000077", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SHOULDER LT DISLOCATION", "code_information": [{"code": "2000144", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SHOULDER LT MULTI VIEW", "code_information": [{"code": "2000078", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SHOULDER RT 1V", "code_information": [{"code": "2000079", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SHOULDER RT DISLOCATION", "code_information": [{"code": "2000143", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SHOULDER RT MULTI VIEW", "code_information": [{"code": "2000080", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR SINUSES LIMITED", "code_information": [{"code": "70210", "type": "CPT"}, {"code": "2000082", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 41.16, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 41.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SINUSES MULTI VIEW", "code_information": [{"code": "70220", "type": "CPT"}, {"code": "2000081", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 48.06, "maximum": 191.26, "gross_charge": 212.52, "discounted_cash": 54.17, "estimated_discounted_cash": 145.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 48.06, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 170.01, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 191.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 121.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SKELETAL SURVEY", "code_information": [{"code": "77075", "type": "CPT"}, {"code": "2000145", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 126.58, "maximum": 432.0, "gross_charge": 480.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 126.58, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 273.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SKULL LIMITED", "code_information": [{"code": "70250", "type": "CPT"}, {"code": "2000084", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 45.36, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.36, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SKULL MULTI VIEW", "code_information": [{"code": "70260", "type": "CPT"}, {"code": "2000083", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 57.09, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 57.09, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SMALL BOWELL", "code_information": [{"code": "74250", "type": "CPT"}, {"code": "2000085", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 160.3, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SOFT TISSUE NECK", "code_information": [{"code": "70360", "type": "CPT"}, {"code": "2000063", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 39.97, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "estimated_discounted_cash": 186.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 39.97, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SPINE C COMP W/ FLEX AND EXT", "code_information": [{"code": "72052", "type": "CPT"}, {"code": "2000088", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 78.35, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SPINE L COMP W/ FLEX EXT", "code_information": [{"code": "72114", "type": "CPT"}, {"code": "2000092", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 78.35, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 78.35, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SPINE SCOLIOSIS", "code_information": [{"code": "72081", "type": "CPT"}, {"code": "2000093", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 54.08, "maximum": 198.96, "gross_charge": 221.07, "discounted_cash": 54.17, "estimated_discounted_cash": 221.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 54.08, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 176.85, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 198.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SPINE SINGLE VIEW", "code_information": [{"code": "72020", "type": "CPT"}, {"code": "2000087", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 31.15, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 31.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SPINE THORACO/LUMB", "code_information": [{"code": "72080", "type": "CPT"}, {"code": "2000095", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 44.27, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.27, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR STERNO-CLAV JOINTS", "code_information": [{"code": "71130", "type": "CPT"}, {"code": "2000097", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 52.62, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 52.62, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR STERNUM", "code_information": [{"code": "71120", "type": "CPT"}, {"code": "2000098", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 42.98, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR T SPINE MULTI VIEW", "code_information": [{"code": "72072", "type": "CPT"}, {"code": "2000094", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 49.77, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 49.77, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR TIB/FIB LT MULTI VIEW", "code_information": [{"code": "2000100", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TIB/FIB RT MULTI VIEW", "code_information": [{"code": "2000099", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TM JOINTS BILAT", "code_information": [{"code": "70330", "type": "CPT"}, {"code": "2000101", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 67.66, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 67.66, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR TM JOINTS UNILAT", "code_information": [{"code": "70328", "type": "CPT"}, {"code": "2000102", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 44.12, "maximum": 182.71, "gross_charge": 186.36, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 149.08, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR TOE LT 1ST", "code_information": [{"code": "2000103", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE LT 2ND", "code_information": [{"code": "2000123", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE LT 3RD", "code_information": [{"code": "2000124", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE LT 4TH", "code_information": [{"code": "2000125", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE LT 5TH", "code_information": [{"code": "2000126", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE RT 1ST", "code_information": [{"code": "2000104", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE RT 2ND", "code_information": [{"code": "2000127", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE RT 3RD", "code_information": [{"code": "2000128", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE RT 4TH", "code_information": [{"code": "2000129", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR TOE RT 5TH", "code_information": [{"code": "2000130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR UPPER EXT INFANT/CHILD", "code_information": [{"code": "73092", "type": "CPT"}, {"code": "2000105", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 40.28, "maximum": 309.04, "gross_charge": 343.38, "discounted_cash": 54.17, "estimated_discounted_cash": 343.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 40.28, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 274.7, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 309.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 195.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR WRIST LT LIMITED", "code_information": [{"code": "2000106", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR WRIST LT MULTI VIEW", "code_information": [{"code": "2000107", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR WRIST RT LIMITED", "code_information": [{"code": "2000108", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XR WRIST RT MULTI VIEW", "code_information": [{"code": "2000109", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 186.36, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XRAY CONTROL CATHETER CHANGE", "code_information": [{"code": "75984", "type": "CPT"}], "standard_charges": [{"minimum": 125.14, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 125.14, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75956", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75957", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE DIST EXT THOR AO", "code_information": [{"code": "75959", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE PROX EXT THOR AO", "code_information": [{"code": "75958", "type": "CPT"}], "standard_charges": [{"minimum": 573.7, "maximum": 573.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 573.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XTRASORB DRESSING 4X5", "code_information": [{"code": "3001376", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XWRAP 1 SQ CM", "code_information": [{"code": "Q4204", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XWRAP Dual, per square  centimeter", "code_information": [{"code": "Q4358", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XWRAP Plus, per square  centimeter", "code_information": [{"code": "Q4357", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XYLOCAINE (LIDOCAINE) 0.4%/500ML D5W 2GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000151", "type": "CDM"}, {"code": "00338040903", "type": "NDC"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "XYLOCAINE (LIDOCAINE) 1% 10MG/ML MDV INJ", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J2003", "type": "HCPCS"}, {"code": "7000285", "type": "CDM"}, {"code": "70756064525", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XYLOCAINE (LIDOCAINE) 2% 20MG/ML 5ML SYR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2003", "type": "HCPCS"}, {"code": "7200156", "type": "CDM"}, {"code": "00409132305", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XYLOCAINE (LIDOCAINE) 2% W/EPI 1:100,000", "drug_information": {"unit": 2.0, "type": "EA"}, "code_information": [{"code": "J2004", "type": "HCPCS"}, {"code": "72000120", "type": "CDM"}, {"code": "00409014710", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XYLOCAINE (LIDOCAINE) 2% W/EPI 1:200,000", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2003", "type": "HCPCS"}, {"code": "72001143", "type": "CDM"}, {"code": "00409318301", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.68, "maximum": 7.39, "gross_charge": 8.22, "discounted_cash": 54.17, "estimated_discounted_cash": 15.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 7.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XYLOSE TOLERANCE TEST", "code_information": [{"code": "84620", "type": "CPT"}], "standard_charges": [{"minimum": 14.85, "maximum": 38.72, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XYNTHA INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7185", "type": "HCPCS"}], "standard_charges": [{"minimum": 16454.23, "maximum": 16454.23, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 16454.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XYZAL (NF-levocetirizine DiHCl) 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002914", "type": "CDM"}, {"code": "31722055190", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "Xceed TL matrix, per square centimeter", "code_information": [{"code": "Q4353", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Xenon Xe-129 hyperpolarized gas, diagnostic, per study dose", "code_information": [{"code": "A9610", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Y90 IBRITUMOMAB, RX", "code_information": [{"code": "A9543", "type": "HCPCS"}], "standard_charges": [{"minimum": 51300.07, "maximum": 51300.07, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 51300.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "YELLOW FEVER VACCINE SUBQ", "code_information": [{"code": "90717", "type": "CPT"}], "standard_charges": [{"minimum": 350.17, "maximum": 350.17, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 350.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "YERSINIA ANTIBODY", "code_information": [{"code": "86793", "type": "CPT"}], "standard_charges": [{"minimum": 15.17, "maximum": 96.7, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "YERSINIA CULTURE", "code_information": [{"code": "87045", "type": "CPT"}, {"code": "1000796", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.86, "maximum": 50.24, "gross_charge": 55.83, "discounted_cash": 54.17, "estimated_discounted_cash": 238.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 44.66, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 23.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 50.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 31.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "YOUTH SIZE BRIEF/DIAPER", "code_information": [{"code": "T4533", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "YOUTH SIZE PULL-ON", "code_information": [{"code": "T4534", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "YT GNOTYP ACHE EXON 2", "code_information": [{"code": "201U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZAIRE EBOLAVIRUS VAC LIVE IM", "code_information": [{"code": "90758", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZANAFLEX (TIZANIDINE CHL) TAB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000817", "type": "CDM"}, {"code": "55111017915", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZANAFLEX (TIZANIDINE) 4MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001505", "type": "CDM"}, {"code": "68084064565", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZANTAC (NF-Zantac) 75 TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002613", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZANTAC (RANITIDINE) LIQUID 150MG/10ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000904", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "251", "type": "RC"}], "standard_charges": [{"gross_charge": 15.4, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZANTAC (RANITIDINE) TAB 150MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000404", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZAROXOLYN (METOLAZONE) 5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000701", "type": "CDM"}, {"code": "00185005501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZAROXOLYN (METOLAZONE) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000468", "type": "CDM"}, {"code": "00185505001", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 3.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZEASORB (NF-Miconazole Nitrate) Powder", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001994", "type": "CDM"}, {"code": "51552012205", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZEBETA (BISOPROLOL FUMARATE) TAB 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000208", "type": "CDM"}, {"code": "70954045510", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZEGERID CAP 20MG-1100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001108", "type": "CDM"}, {"code": "11523726501", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.65, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZEGERID CAP 40MG/1100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000603", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 6.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZENITH AMNIOTIC MEMBRANE PSC", "code_information": [{"code": "Q4253", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZETIA (EZETIMIBE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000266", "type": "CDM"}, {"code": "50228037930", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZIAC (BISOPROLOL/HCTZ) 2.5MG-6.25MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002322", "type": "CDM"}, {"code": "29300018713", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZIAC (BISOPROLOL/HCTZ) TAB 10MG/6.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000780", "type": "CDM"}, {"code": "29300018913", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZIAC (BISOPROLOL/HCTZ) TAB 5MG/6.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000781", "type": "CDM"}, {"code": "29300018813", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZICAM COLD REMEDY RAPIDMELTS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001100", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZICONOTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2278", "type": "HCPCS"}], "standard_charges": [{"minimum": 3582.96, "maximum": 3582.96, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 3582.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZIDOVUDINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3485", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZIDOVUDINE, ORAL, 100 MG", "code_information": [{"code": "S0104", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZIKA VIRUS DNA/RNA AMP PROBE", "code_information": [{"code": "87662", "type": "CPT"}], "standard_charges": [{"minimum": 59.01, "maximum": 87.73, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 59.01, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZIKA VIRUS IGM ANTIBODY", "code_information": [{"code": "86794", "type": "CPT"}], "standard_charges": [{"minimum": 19.38, "maximum": 33.38, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZINACEF (CEFUROXIME) 750MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0697", "type": "HCPCS"}, {"code": "7000087", "type": "CDM"}, {"code": "99999999999", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZINC", "code_information": [{"code": "84630", "type": "CPT"}, {"code": "1000296", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.1, "maximum": 60.66, "gross_charge": 67.41, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 53.92, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZINC GLUCONATE 50MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004323", "type": "CDM"}, {"code": "80681000200", "type": "NDC"}, {"code": "110", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "ZINC SULFATE CAP 220MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000123", "type": "CDM"}, {"code": "20555004000", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZITHROMAX (AZITHROMYCIN) TAB 250", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000496", "type": "CDM"}, {"code": "60687074265", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZITHROMAX 250MG/250ML 0.9% NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0456", "type": "HCPCS"}, {"code": "72000822", "type": "CDM"}, {"code": "70436001982", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZITHROMAX 500MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0456", "type": "HCPCS"}, {"code": "7000495", "type": "CDM"}, {"code": "70095002502", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZITHROMAX 500MG/500ML 0.9% NS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0456", "type": "HCPCS"}, {"code": "72000798", "type": "CDM"}, {"code": "70095002502", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZITHROMAX SUSP (5ML DOSE) 200MG/5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000596", "type": "CDM"}, {"code": "59651000830", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 32.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZITHROMAX TABLET 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001093", "type": "CDM"}, {"code": "00069307030", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 8.6, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZOCOR (SIMVASTATIN) 10MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001060", "type": "CDM"}, {"code": "16729000415", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZOCOR (SIMVASTATIN) 5MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72004324", "type": "CDM"}, {"code": "70377000114", "type": "NDC"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZOCOR (SIMVASTATIN) TAB 20MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000423", "type": "CDM"}, {"code": "70377000314", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZOFRAN (NF-ONDANSETRON) 4MG TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001146", "type": "CDM"}, {"code": "00904655161", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZOFRAN (ONDANSETRON) 4MG/2ML INJ", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "Q0162", "type": "HCPCS"}, {"code": "7000499", "type": "CDM"}, {"code": "23155054742", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "estimated_discounted_cash": 9.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOFRAN (ONDANSETRON) SOL 4MG/5ML", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "Q0162", "type": "HCPCS"}, {"code": "72000977", "type": "CDM"}, {"code": "65162069179", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.96, "maximum": 4.68, "gross_charge": 5.2, "discounted_cash": 54.17, "estimated_discounted_cash": 9.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 3.9, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 4.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 2.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOFRAN (ONDANSETRON) TAB 8MG", "drug_information": {"unit": 8.0, "type": "EA"}, "code_information": [{"code": "Q0162", "type": "HCPCS"}, {"code": "7002001", "type": "CDM"}, {"code": "65862018830", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "estimated_discounted_cash": 9.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOFRAN ODT (ONDANSETRON) TAB 4MG", "drug_information": {"unit": 4.0, "type": "EA"}, "code_information": [{"code": "Q0162", "type": "HCPCS"}, {"code": "7000501", "type": "CDM"}, {"code": "57237007710", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.42, "maximum": 2.25, "gross_charge": 2.5, "discounted_cash": 54.17, "estimated_discounted_cash": 9.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOLOFT (SERTRALINE HCL) 100MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001061", "type": "CDM"}, {"code": "00904692661", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZOLOFT (SERTRALINE) TAB 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000502", "type": "CDM"}, {"code": "00904692561", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.55, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZOLOFT SERTRALINE) 25MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7001145", "type": "CDM"}, {"code": "68180035109", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZONEGRAN", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "1000729", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 27.7, "maximum": 96.2, "gross_charge": 106.89, "discounted_cash": 54.17, "estimated_discounted_cash": 106.89, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 27.7, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 85.51, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 38.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 60.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOSYN (PIPERACILL) 3.375 GM INJ", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J2543", "type": "HCPCS"}, {"code": "7000503", "type": "CDM"}, {"code": "72485040310", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 16.61, "maximum": 26.23, "gross_charge": 29.15, "discounted_cash": 54.17, "estimated_discounted_cash": 37.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOSYN 3.375 GM/100 ML NS IVPB", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J2543", "type": "HCPCS"}, {"code": "72000803", "type": "CDM"}, {"code": "00781311395", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 16.61, "maximum": 26.23, "gross_charge": 29.15, "discounted_cash": 54.17, "estimated_discounted_cash": 37.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 21.86, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 26.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOVIRAX (ACYCLOV) 500MG/100ML NS", "drug_information": {"unit": 100.0, "type": "EA"}, "code_information": [{"code": "J0133", "type": "HCPCS"}, {"code": "72000056", "type": "CDM"}, {"code": "55150015410", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.55, "maximum": 13.5, "gross_charge": 15.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOVIRAX (ACYCLOVIR) 800MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001123", "type": "CDM"}, {"code": "31722077801", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZOVIRAX (ACYCLOVIR) TAB 400MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7000010", "type": "CDM"}, {"code": "31722077705", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZRSR2 GENE COMMON VARIANTS", "code_information": [{"code": "81360", "type": "CPT"}], "standard_charges": [{"minimum": 222.24, "maximum": 222.24, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 222.24, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ZYPREXA (OLANZAPINE) TAB 2.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72000355", "type": "CDM"}, {"code": "55111016330", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 16.77, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZYPREXA ZYDIS (OLANZAPINE) 5MG TAB.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "72001157", "type": "CDM"}, {"code": "33342008307", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZYRTEC (CETIRIZINE) TAB 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7200109", "type": "CDM"}, {"code": "51079059720", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZYVOX (LINEZOLID) 600MG TABLET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "7002412", "type": "CDM"}, {"code": "67877041920", "type": "NDC"}, {"code": "252", "type": "RC"}], "standard_charges": [{"gross_charge": 7.8, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ZYVOX 600MG/300ML INJ", "drug_information": {"unit": 3.0, "type": "EA"}, "code_information": [{"code": "J2020", "type": "HCPCS"}, {"code": "72000908", "type": "CDM"}, {"code": "57664068357", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 17.1, "maximum": 267.21, "gross_charge": 30.0, "discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 267.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "alloPLY, per square centimeter", "code_information": [{"code": "Q4323", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "duoGRAFT AA, per square centimeter", "code_information": [{"code": "Q4376", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "duoGRAFT AC, per square centimeter", "code_information": [{"code": "Q4375", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "mau", "code_information": [{"code": "80000851", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "pBNP", "code_information": [{"code": "83880", "type": "CPT"}, {"code": "1000559", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 45.15, "maximum": 180.81, "gross_charge": 200.91, "discounted_cash": 54.17, "estimated_discounted_cash": 77.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 160.72, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 180.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 114.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "t-TRANS- IgA", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000475", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "t-TRANS-IgG", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "1000488", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.26, "maximum": 61.47, "gross_charge": 68.31, "discounted_cash": 54.17, "estimated_discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}, {"payer_name": "Blue Cross Blue Shield of Alabama", "plan_name": "PPO", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "HMO", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "POS", "standard_charge_dollar": 38.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "triGRAFT FT, per square centimeter", "code_information": [{"code": "Q4377", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "\u03b2-amyloid (Abeta42) and phospho tau (181P) (pTau181), electrochemiluminescent immunoassay (ECLIA), cerebral spinal fluid, ratio reported as positive or negative for amyloid pathology", "code_information": [{"code": "445U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "\u03b2-amyloid (Abeta42) and total tau (tTau), electrochemiluminescent immunoassay (ECLIA), cerebral spinal fluid, ratio reported as positive or negative for amyloid pathology", "code_information": [{"code": "459U", "type": "CPT"}], "standard_charges": [{"discounted_cash": 54.17, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Blue Advantage", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Humana", "plan_name": "HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}]}